Papers

Does actionable feedback on patient safety indicators and responses to disclosed social determinants of health (SDoH) impact clinical behavior? We sent Unannounced Standardized Patients (USPs) with SDoH-related needs to care teams in two urban, safety-net clinics. Data collected on practice behaviors were used for cycles of audit and feedback on the quality of electronic health record (EHR) documentation, team level information sharing, and appropriate service referral. Results suggest disconnect between team data and individual reporting: most report they refer but data suggests few do.

In order to prepare physicians to practice in a rapidly-changing healthcare landscape, medical educators have sought ways to teach, reinforce and evaluate evidence-based practice (EBP). Many instruments exist to evaluate knowledge and skills of how to search and appraise the medical literature, but less is known about how well clinicians apply these skills to patient-level interactions.

Inappropriateness in test ordering patterns were observed through unannounced standardized patient simulated cases. Certain tests (CBC, BMP, LFTs, and HBV) were more likely used wastefully across cases. Between cases, specific tests were ordered in an inappropriate manner (such as TSH for Asthma, LFTs for Fatigue, and BMP for Well visits). The per patient direct cost of low value testing rose above $20 per visit for the well visit, though the fatigue case exhibited the most variation. Notably, this excludes downstream (indirect) costs from standardized encounters alone.

Buprenorphine initiated in the Emergency Department (ED) to treat Opioid Use Disorder (OUD) is a relatively new strategy. Research demonstrates buprenorphine’s effectiveness in decreasing overdose, death, drug use, HIV/HCV infections and crime while improving treatment engagement and social functioning quality. Pairing referral with an initiation of buprenorphine treatment in the ED demonstrated that patients were twice as likely to be in treatment and reported less illicit drug use at 30-day follow up.

Assessment of communication skills is consistent in our OSCE program across UME and GME. Domains include Information Gathering (5 items), Relationship Development (6 items), and Patient Education (3 items) and these are assessed via a behaviorally anchored checklist (scores=% well done) that has strong reliability and validity evidence.

Considerable resources are put into training physicians to be effective providers after residency. Practicing physicians are generally assumed to be more effective and more efficient than resident physicians who are still undergoing training. We capitalize on a unique opportunity to test that hypothesis using the controlled methodology of Unannounced Standardized Patients (USPs), Standardized Patients sent into clinical environments to systematically assess provider skills in the context of a standardized clinical scenario.

Faculty development programs (FDP) can increase clinician educators’ (CE) teaching skills and confidence. The impact of FDP on faculty’s role as educators and their sense of an educator community is less well understood. We evaluated the impact of participation in the Education for Educators program (E4E) on these issues through structured debriefs with participants after they completed the E4E program and then interviews one year later. Participants noted an increased identification with their community of educators.

Family centered care is essential in Neonatal Perinatal Medicine and improvement in communication has been associated with improved family satisfaction. Provision of communication and involvement in care decisions has been shown to be a determinant of positive experiences in the NICU. This is a pilot project that aims to measure the feasibility and effectiveness of improving family-centered communication skills in Neonatal Perinatal Medicine (NPM) Fellows related to challenging physician-parent interactions.

Depression and burnout plague physicians across fields though neurologists are more likely than the average physician to experience burnout. We developed a simulation to effectively train neurology residents to identify and help impaired colleagues. A standardized professional portrayed a depressed co-resident who was abusing alcohol. Residents were evaluated and received feedback regarding their ability to identify and screen for depression and substance use. Early identification of burnout can allow for early implementation of interventions to counteract burnout.

There is an increased awareness among healthcare professionals to discuss social determinants of health (SDOH) information with patients. However, the awareness does not necessarily translate into effective response to the situation. In order to better understand the nuances in such conversations between patients and providers, we reviewed qualitative responses from Unannounced Standardized Patient (USP) portraying patients with SDOH concerns who were seen as part of a study to investigate healthcare teams’ management of SDOH information.