HPEC Poster Session 2024

Context:
Schwartz Rounds (SR) is a live forum for healthcare providers to participate in honest and vulnerable discussions about their experiences providing patient care. Each SR session is focused on a central theme and involves one or more panelists sharing personal experiences, followed by a facilitated group discussion in which attendees are encouraged, but not required, to reflect on what was said and share their own experiences.
A comprehensive review of SR found that SR significantly improved the psychological wellbeing of healthcare workers. While SR for medical students is a relatively new concept, several pilot studies have shown positive feedback from students when comparing SR to traditional methods of reflection. Additionally, implementing SR for medical students may help to increase empathy and compassion for colleagues and patients.

Objectives:
Our objective is to implement a Schwartz Rounds curriculum planned and facilitated by trained medical students with mentorship from experienced members of a Schwartz Center affiliate site. We intend to provide students with an opportunity for productive self-reflection during their transition from preclinical years to clerkships that is targeted to their specific needs.

Description of Innovation:
Three SR sessions were conducted at JABSOM. The planning committee for these sessions consisted of 5 medical students and 3 SR faculty from the Queen’s Medical Center. Each session was facilitated by 2 students from the planning committee, and 2 other students were invited prior to the sessions to share experiences. All 3 sessions were conducted within the same medical school class, in the transition from 2nd into the 3rd year. Feedback was obtained via an adaptation of an evaluation form from the Point of Care Foundation. Attendance and completion of the feedback form were voluntary. The feedback form was anonymous.

Evaluation of Innovation:
The 3 sessions had 12, 13 and 22 attendees respectively, with 13 feedback responses. Overall, sessions received 6 ratings of “Exceptional,” 6 “Excellent” and 1 “Good.” Twelve of 13 respondents completely agreed with 4 statements: “The group discussion was well facilitated,” “This discussion helped with my personal insight and self-reflection,” “I would attend Schwartz Rounds again,” and “I would recommend Schwartz Rounds to classmates.” One “neither agreed nor disagreed” to all 4 statements. For two prospective outlook statements: “I have new insights into the perspectives and experiences of my classmates'' and “I have gained insight that will help me to take care of patients,” 11 of 13 completely agreed; 1 neither agreed nor disagreed and 1 agreed somewhat with each statement. Responses to “I feel more open to expressing thoughts, questions and feelings with my classmates'' were mixed, with 9 of 13 completely agreeing, 2 agreeing somewhat and 3 neither agreeing nor disagreeing.

Discussion/Key Message:
To our knowledge, our pilot study is the first to implement SR in a “by medical students, for medical students” format, whereby trained medical students developed the SR content with faculty mentorship and independently led the SR sessions. One of the key aspects of SR is that it provides a space where individuals can be emotionally vulnerable, and we believe that removing the hierarchical distinction between facilitators and participants helps to achieve the desired environment.

Target Audience:
All medical students in preclinical or clinical years.

Three key words/phrases (not part of character count):
Wellness, compassion, student-run

Introduction: ʻImi Hoʻōla (IH) is a 12-month post-baccalaureate program at the John A. Burns School of Medicine that provides educational opportunities to disadvantaged premedical students with ties to Hawaiʻi and the U.S. Affiliated Pacific Islands. Its mission is to increase the number of physicians who demonstrate a strong commitment to practice in underserved communities and primary care. Since its establishment in 1973, 306 participants have completed IH.

Objectives: To commemorate IH’s 50th anniversary, this study aimed to determine whether IH has worked towards its goal of improving healthcare equity in Hawaiʻi and the Pacific Basin by collecting feedback from alumni regarding the program’s impact on their careers.

Methods: An electronic survey was sent to 263 IH alumni by email from April 2023 to August 2023. The survey collected data on alumni demographics, current working status including specialty, location of practice, populations served, and their perceptions of working in underserved areas before and after completing IH based on a Likert scale. The data was summarized by descriptive statistics.

Results: The survey received responses from 100 IH alumni. The majority of IH alumni are practicing or training in primary care specialties such as internal medicine, family medicine, and pediatrics. For IH alumni who are current medical students, the most interested specialty is internal medicine. Before enrolling, a large number of alumni expressed a strong desire to practice in underserved communities in Hawaiʻi and the Pacific Basin. After completing IH, an even greater percentage expressed their dedication, with over 75% of practicing alumni serving in these areas of need. Furthermore, a majority of residents and medical students expressed a strong desire to practice in Hawaiʻi and the Pacific Basin. The top ethnic populations that practicing and retired IH alumni serve are Native Hawaiians and Pacific Islanders, Asians, and Whites.

Discussion: IH alumni’s choice of specialty shows that IH generates physicians who are willing to fill the primary care gap in Hawaiʻi and the Pacific Basin [1]. The alignment between IH alumni’s origins and choice of practice locations reflects the program's success in retaining current and future healthcare professionals in areas with underserved populations. Although IH is not ethnicity based, many participants come from ethnic minority groups, populations, and communities that are medically underserved. Physicians who come from underserved and minority communities are more likely to provide care to underserved populations [2]. The populations served by IH alumni support that IH is creating alumni who are providing greater access to healthcare in historically underserved populations.
This research is limited by a small sample size due to outdated contact information of alumni and collection of data through electronic surveys. The absence of investigation into other predictive factors on IH alumni’s specialty and location of practice limits the scope of the study. It can be concluded though, that IH has contributed to its goal of improving healthcare equity in Hawaiʻi and the Pacific Basin by increasing primary care physicians and healthcare access to underserved communities. The IH program’s infrastructure works in providing disadvantaged students an opportunity to attend medical school, and it can serve as a template for other medical schools interested in providing alternative pathways for disadvantaged students.

Target Audience: Medical Educators, University Administrators, Diversity Officers

Background: Nearly 1 in 3 diabetic patients have chronic kidney disease (CKD). However, many of these patients are asymptomatic and undiagnosed until advanced stages of disease. Thus, routine screening, early detection, and treatment are crucial for reducing the morbidity and mortality of CKD. Kidney health evaluation fulfillment is defined as having both estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (uACR) testing done within the measurement year. Currently, the national CKD screening rate is approximately 40% and even lower for marginalized groups. Similarly, we found the screening rate in the diabetic population at a primary care practice in West Oahu, which serves a large percentage of Native Hawaiians and Pacific Islanders, to be relatively low. The goal of this quality improvement (QI) project was to identify reasons for care gaps and implement patient outreach interventions to improve the screening rate in this population.

Methods: Chart review of the electronic medical records of 315 diabetic patients at this primary care office was conducted. Dates and results of the most recent eGFR and uACR lab tests were recorded. Patients were then determined to be screened or unscreened. According to screening criteria, patients older than 75, receiving hospice/palliative care, or diagnosed with end-stage renal disease (ESRD) or stage 5 CKD were excluded. Based on the most common reasons for care gaps, three patient-centered outreach interventions were implemented over 6 months. Two text message reminders about overdue lab tests were sent to unscreened patients, followed by two phone call reminders, and finally, two text message reminders to alternative phone numbers, if available. Chart reviews were conducted between each intervention to identify newly-screened patients.

Results: The baseline screening rate was found to be 52.4%. However, 57 patients did not meet inclusion criteria. Of the remaining patients, 58.1% fulfilled the criteria for CKD screening. The most common reason for care gaps among unscreened patients was due to incompleted uACR testing within the last 12 months (79.8%). Incomplete eGFR was the second most common (49%). Text message reminders, phone call reminders, and texts to alternative numbers increased screening rates by 10.8%, 5.5%, and 2.3%, respectively. At the end of 6 months, the screening rate increased by 29.4%, totaling 81.8% of patients screened for CKD.

Conclusion: Increased screening allows for earlier detection and treatment of CKD, thereby reducing its mortality and morbidity. Our findings suggest that suboptimal baseline CKD screening rates for diabetic patients can be increased through patient-centered interventions, with text messages being the most effective and efficient. Secondary analyses may be conducted to determine long-term outcomes, or if screening status is associated with other care measures or features of this population. While these initial results and interventions are limited to this setting, the results can be applied to other areas of primary care and expanded to include a wider scope of patients. Provider-centered interventions, either alone or in combination with patient-centered approaches, may also be a potential area of future research in increasing CKD screening rates.

Target Audience: Physicians, Residents, Medical Students

References:
Ferrè S, Storfer-Isser A, Kinderknecht K, Montgomery E, Godwin M, Andrews A, Dunning S, Barton M, Roman D, Cuddeback J, Stempniewicz N, Chu CD, Tuot DS, Vassalotti JA. Fulfillment and Validity of the Kidney Health Evaluation Measure for People with Diabetes. Mayo Clin Proc Innov Qual Outcomes. 2023 Aug 29;7(5):382-391. doi: 10.1016/j.mayocpiqo.2023.07.002. PMID: 37680649; PMCID: PMC10480072. https://www.mcpiqojournal.org/article/S2542-4548(23)00041-3/fulltext
United States Renal Data System. 2022 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, US Department of Health and Human Services; 2022. Accessed September 1, 2023. https://usrds-adr.niddk.nih.gov/2022
Chu CD, Xia F, Du Y, et al. Estimated Prevalence and Testing for Albuminuria in US Adults at Risk for Chronic Kidney Disease. JAMA Netw Open. 2023;6(7):e2326230. doi:10.1001/jamanetworkopen.2023.26230 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2807656

Introduction
A post-code moment of silence is a designated set of time (a few seconds to a minute) of silence at the end of a code-event when a patient dies to reflect. It is a mindful moment of silence, without action or medicine, to honor a life that has just ended; and time to reflect on the gravity of the role that health care providers play in caring for patients and their families. It may also provide a way to build capacity and resiliency in one of the most difficult clinical situations.

Objectives
To increase the frequency in which this moment of silence occurs at Kapi’olani Medical Center for Women and Children (KMCWC).
To understand attitudes and barriers to having this moment of silence.
To identify and implement ways to lower the barriers for staff to be able to process and move forward after difficult outcomes.

Methods
Data was collected using a pre-implementation survey, followed by educational sessions for the emergency department (ED) and pediatric intensive care unit (PICU) staff at KMCWC. Surveys contained directed questions on previous participation in such events, assessed willingness to participate/lead; as well as open ended questions on overall attitudes and thoughts on participation. Surveys had voluntary participation, using a QR code link on flyers posted in each unit and in staff emails. Educational sessions consisted of reviewing the potential benefits for a moment of silence with ED and PICU physicians, and reviewing sample scripts for initiating. Similar sessions occurred at daily nursing huddles. Development of a script on code-carts in on-going, and a post-implementation survey tool will be distributed in early 2024 to better assess frequency and reassess staff viewpoints of such events.

Results
Of 63 completed surveys, 23% participated in a moment of silence at KMCWC, 31% indicating prior participation in their careers. The majority of respondents, 57.2% indicated feeling comfortable to very comfortable participating in a moment of silence with 9.6% indicating feeling uncomfortable. 21% of those surveyed were comfortable with initiating a post-code moment of silence. Qualitative data collected indicates that healthcare workers are open to moments of silence and find it beneficial. Responses included: “helps to check in with yourself and also take a moment before returning to ‘usual’ duties’” and “extremely beneficial to recognize the patient as a person and human aspect of what we are doing.” Barriers identified were time for a moment of silence, “can be tough depending on what else is going on in the unit” and leadership of the moment; “involvement of the code leader is crucial.” KMCWC is exploring moments of silence into a system-wide effort for improving debriefing.

Discussion
Implementing and educating staff about post-code moment of silence is possible. Staff responses are overall positive. Champions are a must for implementation, guidelines, and pediatric specific scripts would likely aid in occurrence and frequency. Further exploration of utility and benefit is on-going.

Introduction: Learning gross anatomy is an integral part of medical education, and having a solid foundation of anatomical knowledge is essential for clinical practice. However, anatomy continues to be a source of stress for many medical students, especially first years (MS1s). An initial survey was sent out to an MS1 class to gather interest for peer-led anatomy review sessions, and the results showed sizeable interest. Peer teaching was chosen because it benefits both the learner and the student tutors. It has been shown to create a safe and comfortable environment for students to learn and discuss, and also improves knowledge retention, leadership, and confidence in student tutors.1,2,3 This project explores how peer teaching can be utilized in the anatomy curriculum.

Objectives:
The main objectives of this project were as follows:
1) Analyze the effectiveness of peer-led anatomy review sessions in reducing stress levels in students.
2) Assess the effectiveness of peer-led anatomy review sessions in helping to better prepare students for their anatomy exams.
3) Determine the need for peer-led anatomy review sessions.
4) Evaluate the effectiveness of teaching anatomy in helping to better prepare students for USMLE Step 1 or USMLE Step 2 exams.
5) Estimate stress level of student tutors when preparing for review sessions.

Innovation: Peer-led review sessions were held on a weekly basis in the gross anatomy lab. Each session was led by either a second, third or fourth year medical student. Group sizes were kept small to facilitate better learning, and approximately 8-10 MS1s attended each session. Tutors were provided relevant lecture material and a list of structures to cover (“fair game topics list”) prior to their sessions. The format of the sessions varied and ranged from a guided review to a question-and-answer format. An online sign up sheet was sent out to the MS1 class weekly, and spots were filled on a first-come first-serve basis. At the end of each unit, a survey was sent out to the entire MS1 class to evaluate the effects of the anatomy review sessions in reducing stress levels and helping to prepare for exams. A survey was also sent out to 18 student tutors to evaluate how teaching review sessions affected them.

Evaluation of Innovation: A total of 66 responses were collected among the students who attended an anatomy review session over three different units. Of these responses, 92% (n=61) agreed they felt stressed at the beginning of each unit, 89% (n=59) agreed they felt less stressed after attending a review session, and 94% (n=62) agreed they felt the review session helped better prepare them for the final practical exam. All responders (n=66) agreed that the peer-led review sessions are valuable and should be continued. A total of 13 responses were collected from the student tutors. Of these responses, 11 students believed that teaching helped better prepare them for the USMLE 1/USMLE 2 exam, and 2 students felt stressed while preparing for the review session. All student tutors agreed they would be an anatomy tutor again.

Discussion: Overall, the peer-led anatomy review sessions were met with favorable feedback. The sessions effectively reduced the students’ stress levels about anatomy, and helped them better prepare for their final practical exam. Student tutors also benefited from these sessions, and many agreed it helped better prepare them for their respective licensing exams. All students who attended a review session agreed that peer-led anatomy review sessions should be continued, which highlights a potential opportunity within the medical education curriculum.

Target Audience: Medical educators, medical schools, medical students

References:
Tanveer MA, Mildestvedt T, Skjærseth IG, et al. Peer Teaching in Undergraduate Medical Education: What are the Learning Outputs for the Student-Teachers? A Systematic Review. Adv Med Educ Pract. 2023;14:723-739. Published 2023 Jul 11. doi:10.2147/AMEP.S401766
Ten Cate O, Durning S. Peer teaching in medical education: Twelve reasons to move from theory to practice. Medical Teacher. 2007;29(6):591-599. doi:10.1080/01421590701606799
Tullis JG, Goldstone RL. Why does peer instruction benefit student learning?. Cogn Res Princ Implic. 2020;5(1):15. Published 2020 Apr 9. doi:10.1186/s41235-020-00218-5

Title:
"Assessing Interest and Awareness Among Japanese Medical Students in International Standardized Testing: The Introduction of the National Board of Medical Examiners (NBME) Comprehensive Basic Science Examination (CBSE) in Japan"

Authors and Affiliations:
Emi Saegusa-Beecroft, M.D., Ph.D.1,2,4
Kentaroh Takagaki, M.D., Ph.D., B.Agr.3
Junji B. Machi, M.D., Ph.D., FACS1,2,4

1. Office of Global Health and International Medicine, John A, Burns School of Medicine, University of Hawai`i at Manoa
2. Department of Surgery, John A, Burns School of Medicine, University of Hawai`i at Manoa
3. Department of Anatomy and Systems Biology, Faculty of Medicine, University of Yamanashi, Japan
4. JrSr Corporation, Japan (A Non-profit Educational Organization)

Introduction:
Since 2016, the University of Hawaii John A. Burns School of Medicine, in partnership with the JrSr Corporation and 14 out of 82 medical schools in Japan, has been offering the Hawaii Medical Education Program (HMEP). This program offers clinical clerkships, workshops, on-demand course materials, and live online classes, all focused on global health and international medical standards. This study's primary goal was to examine the feasibility of rolling out the National Board of Medical Examiners (NBME) Comprehensive Basic Science (CBSE) and Clinical Science Examinations (CCSE) in Tokyo, potentially impacting the U.S. healthcare workforce, highlighted by Non-U.S. International Medical Graduates comprising 27.2 percent of all primary care positions in the 2023 U.S. match [1], with a particular focus on Hawai'i due to its significant Japanese heritage community (16.5%) [2].

Objectives:
1. To assess the level of interest among Japanese medical students in internationally standardized medical testing, specifically the USMLE Step 1 and NBME shelf examinations.
2. To present the implementation of the NBME CBSE and CCSE in Japan, affirming our HMEP program's direct role in this educational advancement.

Methods:
Using Google Forms, an online anonymous survey was conducted across 14 medical schools, with 1900 students on the HMEP mailing list (20% of medical students). Of those, 279 students (15%) were active participants, defined by direct participation in any of the HMEP curriculum. Participation was voluntary, and data were collected and analyzed by two independent researchers.

Results:
Out of 115 survey responses, 101 responses from medical students were retained (36% of active students), and the other responses from residents and faculty were excluded. Among the valid responses (n=99; 79 pre-clinical and 22 clerkship students), 98% expressed interest in participating in a testing-center-based NBME CBSE (n=97), with 23% strongly determined to take the exam (n=23). Only 1 student was not interested in the USMLE Step 1. While 55% (n=54) planned to take the Step 1 exam during medical school, 8% (n=8) intended to do so during post-graduate residency, and one third remained undecided (35%, n=35). Respondents cited various reasons for pursuing clinical training in the U.S., including experiencing advanced medical practice (64%, n=63), a desire to live in the U.S. (35%, n=35), perceived higher physician compensation (26%, n=26), a desire to see the world (83%, n=82), a passion for global healthcare and international medicine (60%, n=59), and the belief in potential career advantages within Japan (22%, n=22). Regarding the USMLE Step 1, 47.5% (n=47) faced challenges in balancing exam preparation with extracurricular activities and their busy Japanese medical curriculum, while 62% (n=61) found gathering information for effective preparation challenging.

Discussion:
Survey results show strong interest for the NBME CBSE and CCSE at testing centers among Japan's medical students. A majority wish to train in the U.S., aiming for the USMLE. Although this study was limited by its voluntary nature, the survey offers insights into the ambitions and barriers of the responders who are highly-motivated students pursuing international medical careers, who may stand to benefit from new center-based exams, particularly for U.S. residencies.

Conclusion:
The introduction of NBME Shelf Examinations in Japan by the HMEP marks a significant milestone in aligning Japanese medical education with international standards. This initiative is a substantial contribution to the modernization of medical education in Japan. It addresses the strong demand from students aiming for international medical careers and enhances proficiency in professional English communication. The successful implementation of these examinations is anticipated to profoundly impact the global healthcare workforce, including in the U.S., by producing a generation of medical professionals equipped with global competencies and perspectives.

Target Audience:
International Medical Students, Medical School Faculty, Medical School Administrators, Medical Education Researchers.

References:
[1]https://www.nrmp.org/wp-content/uploads/2023/05/2023-Main-Match-Results-and-Data-Book-FINAL.pdf
[2] 2020 Unites States Census

Faculty Development: JABSOM Partnering with HPMG Clinical Sites

Dee-Ann Carpenter, MD, JABSOM Department of Native Hawaiian Health and Office of Medical Education;
Martina Kamaka, MD, FAAFP, JABSOM Department of Native Hawaiian Health;
Bradley Chun, MD, HPMG Medical Director of Undergraduate Medical Education, JABSOM Department of Medicine;
Maile Tauali‘i, PhD, MPH, Collaborative Investigator;
Marcus Iwane, MD, Chief, Kaiser Permanente West Oahu Medical Office, JABSOM Department of Medicine;
Jeani Jow, PharmD, Director, Medical Education and Primary Care Operations, HPMG

Context:
Faculty Development for clinical faculty is needed whenever medical school curricular changes are made that impact clinical faculty. The John A. Burns School of Medicine (JABSOM) recently initiated a Longitudinal Clinical Preceptor (LCP) program for first and second year medical students, to supplement JABSOM’s core Problem-Based Learning (PBL) curriculum. Students meet with their LCP monthly. This curricular change requires more LCPs, who may need a basic understanding of medical school curricula, i.e. education and exposure students have had and what gaps may still exist in their education and training.
HPMG (Hawai‘i Permanente Medical Group) is composed of physicians at Kaiser Permanente, some of whom have become LCPs. Recently, HPMG Undergraduate Medical Education leadership reached out to JABSOM faculty about designing a half day faculty workshop to address some gaps in LCP knowledge about JABSOM’s medical student curriculum, anticipating that this workshop would be able to provide basic information so that the LCP could work more effectively with their medical student learner. JABSOM faculty were asked to partner in the planning for this faculty development and subsequent discussions have solidified an agenda.

Objectives:
Discuss an innovative collaborative faculty development workshop designed by JABSOM medical educators and HPMG to address knowledge and skills gaps for longitudinal clinical preceptors.
Describe how knowledge and skills gaps around understanding PBL, addressing feedback, and incorporating indigenous health were addressed in the faculty development workshop.

Description of Innovation:
Faculty workshop agenda addressed certain gaps identified by HPMG in discussions with their longitudinal clinical preceptors. The workshop will take place on Nov. 11, 2023 with an anticipated fifteen clinicians. Many clinicians will be longitudinal clinical preceptors in the inpatient or outpatient setting. In addition, team leads (in charge of HPMG physicians who work clinically with students), and physicians who teach third year medical students during longitudinal integrated clerkships will be in attendance. The agenda begins with cultural grounding in Native Hawaiian health, as it is incorporated into the JABSOM curriculum as well as with HPMG physicians. The rest of the agenda covers topics including: “tips for understanding todayʻs student learners,” giving feedback (including tools and resources for working with the “difficult” student), familiarization with the basics of Problem Based Learning, overview of clinical skills teaching, and finally, advice and perspectives from PBL tutors and Longitudinal Clinical Preceptors. These are all lecture style presentations, using case scenarios to involve audience participation.

Evaluation of Innovation:
A post-curricular assessment will be given to all attendees immediately following and a few months after the workshop. The workshop is taking place after the submission date for the abstract. Therefore, results will be available and shared at the time of the HPEC conference. We hope to see a change in behavior of the preceptors so that the students are able to see a difference in their teaching, more efficient, effective teaching encounters with cultural grounding, as well as more personalized student feedback.

Discussion/Key Messages:
The following are the key messages from the workshop:
Cultural grounding is important for not only medical learners but also teachers. In an Indigenous space, that includes knowing the basics about Indigenous health statistics, history, values and cultural strengths.
Clinical teachers of medical students (those teaching “at the bedside” or in clinical settings) need to have a basic understanding of medical student educational curricula and content in order to prepare for effective teaching encounters.
Teachers or preceptors should have an idea of the content that medical students should already have mastered as well as an understanding of where gaps may exist.
Giving effective feedback is an important skill for clinical instructors and medical schools should ensure that faculty are trained in this teaching responsibility.
It is our hope that this type of workshop can be easily incorporated into the clinical teaching setting.

Target Audience: medical educators

Education context: Since it was first introduced in medical education literature in the late 1990s, Narrative Medicine (NM) has become increasingly researched as a form of pedagogy for medical learners of all levels. NM is an approach that employs the skills needed to recognize, absorb, interpret, and be moved by stories of illness (Charon 2007). It is concerned with making meaning of the experiential knowledge within patients stories and integrating this with medico-pathological knowledge and modern, data driven medical narratives. A wide variety of NM-related pedagogic interventions have been described in the literature. A common goal among these is proficiency in clinic-based patient-centered interviewing in order to create a rich patient narrative. Opportunities to practice mental schemas like FIFE (Feelings, Ideas, Function and Expectations) can be especially helpful for new learners (Weston et al.1989).

Objective: Participation provides an opportunity to hone skills relating to NM, such as active listening, self-reflection, the process of empathy building, comfort with synthesizing a patient-centered interview and narrative writing.

Description of Innovation: Our innovation is an Instagram account (@somebodystories) that documents the lived experiences of someone with a chronic illness, covering diseases of various organ systems. Each illness covered includes three posts of background information to help users better contextualize the interview and six posts of interview-based summaries. The participant conducts a semi-structured interview with a volunteer who has that given illness. Participants are involved in 1) Identifying a patient, 2) Interviewing, 3) Gathering background information, 4) Summarizing background information and interview content into posts using layman’s terms. To maintain consistency, we utilize the same background research template and interview guide. Volunteers are informed verbally and through writing that any identifying information is omitted from the posts and that interview-based content is posted only after their approval.

Evaluation of Innovation: We will utilize a pre and post survey. Both include components of the Kirkpatrick model, which is widely used to evaluate the utility of an educational intervention. All participants complete a pre survey. Participants who lead at least one interview or help to craft a narrative from the raw interview are given a post survey, to be completed within 1 week of their work. The volunteer interviewees are also sent an optional feedback form.

Discussion/Key Message This innovation is a novel approach to Narrative Medicine that utilizes patient-centered interviewing and social media. It also aims to amplify local stories from Hawai’i.

Target Audience The participant who is involved in creating an interview-based Instagram post.

Title: Innovation in Patient Safety Education for Learning Communities

Authors: Eyrica S. Sumida B.S, Melanie H. Teruya B.A, Vanessa S. Wong M.D, Kyra A. Len M.D, Travis S. Hong M.D

Context:
In Fall 2020, the John A. Burns School of Medicine implemented a Learning Community (LC) program to enhance the existing curriculum. One of the primary objectives of LC is to help learners understand health systems science, with a focus on identifying barriers to high-quality care and patient safety.

Objectives:
The primary objective of this scavenger hunt is to increase students’ confidence in identifying patient safety hazards in a hospital setting through a small group activity and discussion. A secondary objective is to determine the efficacy of this type of simulated learning environment for fourth year medical students.

Description of Innovation:
In 2022 and 2023, fourth year medical students participated in a patient safety scavenger hunt with their LC groups. Students were tasked with identifying as many patient safety hazards as possible in both an adult and pediatric hospital room setting, within a set time interval. Led by their faculty mentor, students debriefed and, using a QR code, accessed brief teaching points that further described specific safety hazards. At the completion of the activity, students completed a post-survey.

Evaluation of Innovation:
A post-program survey determined that 93.8% of 65 students in the 2022 cohort and 87.5% of 40 students in the 2023 cohort agreed that the program helped them identify patient safety errors in a hospital setting. Students also showed statistically significant increases in confidence in their abilities to identify various patient safety hazards, strategies to improve patient safety, and indications for infection precautions, as well as to recognize risk factors for catheter-associated urinary tract infections (CAUTI), falls, restraints, decubitus ulcers, medication errors, skin breakdown, and errors during a code.

Discussion/Key Message:
The patient safety scavenger hunt successfully helped 4th year students increase their confidence in identifying patient safety hazards as well as strategies to improve patient safety. Utilizing a simulation activity with faculty-led discussion allowed them to share ideas and discuss how to improve the performance of our healthcare system at a larger level. An early emphasis on recognizing these hazards promotes student awareness before entering residency. For future sessions, we recommend extended discussions on necessary steps after recognition of these safety hazards while placing increased emphasis on how interdisciplinary teams can approach patient safety.

Target Audience:
Target audience includes medical students who are in the clinical phase of their education and other learning community mentors. Developing confidence in identifying, discussing, and even remediating patient safety hazards is important for students about to enter residency programs where they will be expected to manage patient care and safety. Learning community mentors at JABSOM and other institutions can also use an activity like this to incorporate patient safety into their curriculum as well.

Introduction:
Adverse Childhood Exposures (ACEs) were first identified by Felitti et al. through surveys sent to 9,508 respondents. More than half of the respondents had exposure to at least one ACE. Furthermore, there was a graded relationship between the number of ACEs experienced and the odds ratio for experiencing adverse health outcomes such as severe obesity, ischemic heart disease, any cancer, stroke, etc.

Objectives:
Increase community awareness about the significance of ACEs
Increase provider engagement in administering ACE screening questionnaires and providing appropriate interventions
Increase patient engagement in completing ACE screening questionnaires

Methods:
When Kaiser Permanente West Oahu Medical Office at Kapolei began screening for ACEs, all the screening questionnaires were completely negative. The Pediatric ACEs and Related Life Events Screener (PEARLS) questionnaires were being given at the front desk attached to the routine one year questionnaire without any explanation or cover letter. We hypothesized that the inclusion of a cover letter and re-ordering the items on the PEARLS would improve patient engagement and comfort with responding.

Results:
De-identified responses to ACEs screening questionnaires were recorded from the beginning of administration throughout the implementation of both the cover sheet and the re-orderd PEARLS. The average total scores for the original PEARLS, cover sheet with the original PEARLS, and cover sheet with revised PEARLS was recorded. The re-ordered PEARLS given with a cover sheet had the highest average total score, followed by PEARLs given with a cover sheet, then PEARLS given without a cover sheet.

Conclusion:
The implementation of a cover sheet and re-ordering the items on the PEARLS seemed to improve patient engagement with the questionnaires, suggesting that these alterations may increase patient comfort in disclosing ACEs. For patients who responded to the questionnaires, appropriate referrals and resources were provided.

Desired impact:
This project was created to encourage health professionals to consider the relationship between ACEs and pediatric patient health and how questionnaires addressing sensitive topics may be administered for optimal patient engagement.

Vincent J Felitti, Robert F Anda, Dale Nordenberg, David F Williamson, Alison M Spitz, Valerie Edwards, Mary P Koss, James S Marks, Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study, American Journal of Preventive Medicine, Volume 14, Issue 4, 1998, Pages 245-258, ISSN 0749-3797, https://doi.org/10.1016/S0749-3797(98)00017-8.
Petruccelli K, Davis J, Berman T. Adverse childhood experiences and associated health outcomes: A systematic review and meta-analysis. Child Abuse Negl. 2019;97:104127. doi:10.1016/j.chiabu.2019.104127
Zhang X, Monnat SM. Racial/ethnic differences in clusters of adverse childhood experiences and associations with adolescent mental health. SSM - population health. 2022;17:100997-100997. doi:10.1016/j.ssmph.2021.100997