Medical Student Preparatory Resource to Excel in Pediatrics: A Quality Improvement Project

Ishida, Lauren
Ip, Carrie
Mizuo, Barry
Len, Kyra
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Background: The transition to clinical clerkships brings many new experiences, which can incite feelings of unease in third year medical students (MS3s). During the pediatric inpatient rotation, MS3s describe challenges surrounding family centered rounds (FCR) and oral presentations, leading to feelings of self-doubt, unpreparedness, and anxiety. Objective: Through a quality improvement process, resources were developed and disseminated in multiple phases, with the primary aim of reducing self-reported anxiety scores and increasing preparedness for FCR. The secondary aim was to involve faculty and residents in improving the pediatric clerkship experience and incentivizing their participation with maintenance of certification (MOC) part 4 points. Methods: We developed and measured the efficacy of preparatory resources (such as electronic medical record informational videos and presentation templates) for all MS3s to use on the pediatric rotation in 3 phases, with each new phase commencing with the new academic year. Anxiety and preparedness were assessed with Likert scales graded 1-5, via surveys that were administered during the clerkship orientation, and at conclusion of the 4-week rotation. For phase 3, we created worksheets to introduce the development of assessments and organization for FCR oral presentations, and improved access to supplemental videos and resources from phases 1 and 2. Regular meetings with faculty and residents were used to disseminate information about the resources, students’ comments, and to solicit feedback. Surveys were also given to residents and attending physicians to assess efficiency of MS3s during the rotation. Results: During the ongoing phase 3, perceived preparedness for the rotation increased from 2.3 pre-rotation to 4.0 at the end of the rotation (p-value = 0.0000027). FCR preparedness increased from 2.4 to 4.4 (p-value = 0.00000000014), as compared to the increase from 2.6 to 3.6 (p-value = 0.0000078) in phase 2. FCR anxiety decreased from 3.5 to 2.5 (p-value 0.002), compared to the lack of change in FCR anxiety in phases 1 and 2. Sixty-seven percent of the hospitalist faculty participated, particularly with feedback. Residents reported spending an average of 30-40 minutes in phase 1, and 10-20 minutes in phases 2 and 3 to orient the MS3s. Discussion: By providing worksheets and showing our supplemental videos in phase 3, we demonstrated improvement in MS3s’ perception of preparedness for both FCR and the rotation as well as a decrease in anxiety for FCR compared to our previous phases. Anxiety is a personal and subjective measure, which may account for the variability in responses, thus student testimonials are included in the surveys. This quality improvement initiative not only benefits students and physicians, but also facilitates a concise and informative FCR to enhance patient care and could be adapted for other MS3 clerkships. Phase 3 will conclude in May 2022.
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