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    The Emerging Role of the Pharmacist in Managing Poisoning Cases: A Systematic Review
    (2022) Simpson, Payton
    Purpose: In 2019, a total of 2,573,180 calls were made to poison control centers across the United States. This equates to 1 exposure every 15 seconds, and of the top 10 agents reported in exposures, 5 were pharmaceutical products or prescription medications. This presents the question, what went wrong in these cases? While many poisoning exposures are accidental, some can be attributed to either a lack of knowledge regarding the proper use of the product or improper storage. With prescription medications listed among the top agents, there is a growing need for pharmacists to prevent, and treat poison exposures. The objective of this study was to review the literature and assess the role of the pharmacist in managing poisoning cases. This review aimed to analyze the pharmacist's specific role, associated duties, and necessary skills. A secondary objective was to analyze the literature for common practice sites of pharmacists and describe barriers to participation in poisoning cases. Methods: A systematic review of the current literature was performed using PubMed and SCOPUS. The search included a combination of terms "pharmacist" and "poisonings." Articles dated 2000 to 2020 were included to reflect most current practice. Articles were excluded if they were not from the U.S., not directly related to poisonings, or if the full text was unavailable. Search results from each database were exported to Microsoft Excel and sorted for removal of duplicate citations. Articles were graded on the Oxford scale based on study design and quality of evidence. Data reported from each article was categorized by: study objective, intervention, practice site, pharmacists' role, and skills needed. Additionally, barriers or challenges to pharmacist participation in poisoning cases were documented. Results: The search results from PubMed using search terms 'pharmacist' and 'poisonings' yielded 462 articles. The same search terms in SCOPUS yielded 287 articles, after duplicates were removed there was a total of 666 articles. Records were screened and 591 were excluded with 74 remaining to be assessed for full-text eligibility. Ultimately, 36 full-text articles were assessed and utilized. Article types included retrospective analyses, editorials, surveys, and case reports. When examining the literature for the role of the pharmacist; collaboration and education were the most frequently documented roles. Further specified roles included knowledge of antidotes, supportive care, patient presentation of common poisonings, protocol development, and program implementation. Common practice sites included: Poison Control Centers, hospitals, and community settings. Many articles presented opportunities for pharmacists to intervene however, pharmacists must overcome barriers and challenges. These included but were not limited to: lack of toxicology training, limited pharmacist involvement on the healthcare team, and no documentation of interventions. Conclusions: As drug therapy experts and one of the most accessible healthcare providers, pharmacists can serve a vital role on the healthcare team. Through toxicology training and collaboration with other providers, pharmacists can aid in the treatment of these cases, and in preventing future exposures. In the future, pharmacists should be included in the care and management of poisoning cases.
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    Delivering Caregiver Education to Dementia Family Caregivers in the Primary Care Setting
    (2022) Thompson, Sadie; Hadley, Lesca; Daley, Rebecca
    Study Objective The purpose of this study is to determine whether dementia caregiver education can be distributed at clinic visits in the primary care setting. Family caregivers of those with dementia report being significantly more stressed when compared to non-dementia caregivers.2 Negatively impacted health outcomes for family members increase the total burden of dementia on the health care system. This study aims to equip dementia caregivers with resources that help them cope with caregiver-associated stress. Methods This study took place in a rural primary care setting over a five-week period. Educational brochures were designed to provide family caregivers with coping strategies, communication strategies, and support group information. Family caregivers were identified upon their accompaniment of a patient with dementia to their appointment. Results During this period seven patients with an established history of dementia attended routine appointments accompanied by a family caregiver. Caregivers of all seven patients received an educational brochure and were counseled on the contents of the brochure for at least five minutes. At the point of enhancement, caregivers expressed gratitude at the acknowledgment of the burden of caregiving and the receipt of the educational materials. Conclusions and Limitations The results of this study support the ability of primary care providers to increase the education of dementia caregivers at regular office visits. Limitations to this study include the ability of family caregivers to attend appointments with dementia patients and patient identification of family caregivers. Further studies should be done to evaluate dementia caregiver stress before and after receiving education on caregiving. References: 1. Caregiving for Family and Friends - A Public Health Issue. Centers for Disease Control and Prevention. Published July 30, 2019. Accessed July 16, 2021. 2. Cheng ST. Dementia Caregiver Burden: a Research Update and Critical Analysis. Curr Psychiatry Rep. 2017; 19(9). doi: 10.1007/s11920-017-0818-2
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    (2022) Jackson, Garrett; Oh, James; Gibson, John; Grieb, Gavin; Banh, Debini; Son, Min Ji; Thomas, Alexander; Quach, Shanon; Terlizzese, Taylor; Abella, Matthew
    Point-of-care ultrasound (POCUS) continues to become more widespread due to its range of use, low cost, and extremely high level of patient safety. It is imperative that we train medical professionals to utilize this tool in its fullest capacity as its diagnostic accuracy varies drastically with the skill and experience of the provider. Many programs recognize this discrepancy and have begun implementing POCUS earlier in training within medical school curricula. Despite these efforts, training across the broad application of POCUS continues to be underutilized in anatomy that is less accessible due to reservation amongst peers and patients. Testicular and scrotal anatomy is one of these sensitive areas that is lacking in early hands-on training. Ultrasound remains the first-line modality in the evaluation of scrotal disease. For emergent etiologies of acute scrotal pain or swelling, timing largely determines prognosis; any delay in care significantly increases risk of tissue necrosis, compromising the fertility of the patient. A solid foundation in acquiring and visualizing normal scrotal anatomy on the human body is an essential first step in creating the adept POCUS provider. Utilizing fresh, unfixed cadavers as ultrasound screening specimens for scrotal anatomy may be a feasible option for initiating early training in scrotal POCUS. Supported by the Willed Body Program, cadavers were screened with hand-held Butterfly iQ+ ultrasound devices by members of the ultrasound teaching assistant cohort of 3rd and 4th year TCOM students. Ultrasound acquired images and clips were reviewed and evaluated by a trained faculty member. Of the images obtained 17 out of 20 cadavers (85%) adequately visualized pertinent structures of scrotal anatomy in the absence of significant imaging artifacts. The Butterfly iQ+ ultrasound provided excellent quality images with minimal artifacts; the scrotum is an easily accessible organ that avoids the early processes of decomposition which can obscure image acquisition. However, given the lack of blood flow, color and power doppler settings were unable to be adequately utilized. These settings are crucial in the diagnosis of certain scrotal pathologies such as epididymitis, varicocele, testicular torsion and orchitis. In conclusion, the provider's first time obtaining and assessing scrotal anatomy on a human body should not be in a time-limited, emergent situation. Fresh, unfixed cadavers can provide a means for closing the gap in providing scrotal anatomy training at the medical school level and ultimately elevate patient care. Benefits to this approach include: increased diagnostic and visualization skills of normal structures, augmented visuo-spatial and tactile probe-handling skills, enhanced ability to compensate for artifact and variations in anatomy, and practice handling the patient with professionalism and care. Future projects could include using cadavers to artificially replicate pathologic conditions for advanced training in diagnostic and procedural skills.
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    Incorporating Medical Students into the Development of Age Friendly Healthcare Systems through Quality Improvement Projects
    (2022) Thompson, Sadie; Miller, Cassidy; Jackson, Garrett; Hadley, Lesca; Gibson, John; Severance, Jennifer
    Purpose: The world is aging. Health systems are often not prepared for the number or complexity of geriatric patients. Caring for this vulnerable population through age-friendly health systems is imperative for our future. With the universal lack of geriatricians, family physicians primarily care for the elderly population and are therefore ideally placed to lead changes to improve the lives of geriatric patients. The Rural Osteopathic Medical Education (ROME) Program partnered with UNTHSC's Center for Geriatrics to create geriatric-focused quality improvement projects (QIPs) for medical students to complete in their family medicine clerkships. Methods: Two cohorts of ROME students interviewed rural family physicians regarding the needs of their geriatric patient population. Students then partnered with the physician to develop geriatric QIPs which were implemented in the clinics. Following the conclusion of the projects, students were surveyed about their experience implementing geriatric QIPs during their clerkships. Results: In the first cohort, 100% of students stated that they were better able to analyze, collect, and communicate data about quality improvements in practice. 100% of students in this cohort stated that they would integrate QIPs into their practices. In the second cohort, 76% of students stated that they were better able to analyze and collect data for QIP. In this cohort, 71% of the students stated that they would actively integrate QIPs into their practices. 67% of the family physicians strongly agreed that QIPs were useful to their practice. Conclusions: Students identified best practices to address the health needs and concerns of older adults and their caregivers. The QIPs improved care for the elderly in addition to providing experience in implementing quality improvement methods that can be used in the students' future medical practices. Incorporating medical students into QIPs in family medicine clinics is valuable for the patients, students, and physicians.
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    Ultrasound Microcredential: A Novel Method to Enhance Ultrasound Education
    (2022) Weindruch, Louisa; Miller, Cassidy; Wyszynski, Katy
    Purpose: Over the last several years, access to ultrasound has increased dramatically, making point of care ultrasound (POCUS) a diagnostic standard across many medical specialties. It is cost effective, non-invasive, and becoming even more portable. Physicians can now take ultrasound where it previously was unavailable, such as rural areas, ambulances, and foreign countries for medical missions. Despite its expanded use and applicability, many medical schools remain behind in developing and implementing ultrasound education. Currently, the University of North Texas Health Science Center Texas College of Osteopathic Medicine (UNTHSC TCOM) integrates ultrasound education into the first and second years of medical education as part of their system courses, physical exam class, and simulations labs. To augment the ultrasound experience and improve students' skill set, UNTHSC has developed three ultrasound microcredential courses. The microcredential program is a two-day course that allows students, residents, and practicing physicians to earn a certification in a specific area of point of care ultrasound. Methods: Under the direction of Dr. John Gibson, students can enroll in one of three microcredential courses -- Primary Care, Obstetrics and Gynecology, or Emergency/Critical Care. Each course is divided into three parts. First, prior to attendance of the in-person workshop, students are required to complete the relevant online SonoSim modules. Secondly, students will attend the 10-hour in-person workshop that culminates with an evaluation of their ultrasound skills. Students are given the opportunity to practice on standardized patients with the help of trained ultrasound teaching assistants. In addition, they must correctly identify pathology and perform simulated ultrasound-guided procedures. Students must receive a certain number of points on a graded rubric during the in-person portion of the workshop. Lastly, following the workshop, participants are required to obtain images on their own using a Butterfly IQ ultrasound. These ultrasound studies are reviewed by UNTHSC faculty. Once students have completed and passed all three components of the workshop, they are awarded the microcredential for that course. Results: The goals of the microcredential are twofold: to demonstrate an effective model for students to learn point of care ultrasound, and to expand ultrasound teaching to residents and attending physicians, to learn new techniques or build upon their current knowledge. We are in the process of evaluating our program using student feedback from a comprehensive post-workshop survey. Preliminary feedback has shown that students enjoy the workshop and find it an effective way to learn ultrasound. Conclusion: Overall, we hope that the UNTHSC POCUS Microcredential Program can be a model for other schools looking to advance their ultrasound training for both students and residents, practicing providers, and other members of their community.
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    Point of Care Ultrasound Diagnosis of Deep Vein Thrombosis by Medical Students
    (2022) Miller, Cassidy; Thompson, Sadie
    Deep venous thrombosis (DVT) is the most common type of venous thromboembolism. The feared complication of a DVT is the progression to a pulmonary embolism. Many DVTs can resolve spontaneously but screening and diagnosis are important for management to decrease progression to a pulmonary embolism and reduce the risk of morbidity and mortality. The purpose of this study was to determine if point-of-care ultrasound sonography by third-year medical students is sufficient in the diagnosis of a DVT. Students were trained on two point DVT screening using an in-person training session and an on-line training module. While on their family medicine rotations students obtained images of their screenings using a hand-held ultrasound and uploaded them to be graded. Studies will be deemed satisfactory if five out of six images obtained correctly identify the appropriate structures. The eleven students that participated completed a total of 110 studies. Of these studies a total of 97 studies were deemed satisfactory after expert review, for an overall study satisfaction of 88.18%. Of the eleven students, seven participants had 100% satisfaction in their studies, one had 90%, one had 80%, one had 70% and one had 40%. We conclude that students are able to obtain satisfactory images of the deep legs of the vein using point of care sonography after a 1 hour training session. All students except for one who participated were able to demonstrate competency from the study images that were obtained and reviewed. Third year medical students can be proficient enough with point-of-care ultrasound to screen for DVT. This has great application for rural medicine as well as these portable ultrasounds were sufficient enough to complete these screenings.
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    Diabetic Foot Health Education Quality Improvement Project
    (2022) Miller, Cassidy
    Diabetic foot health is an important facet of overall health in diabetic patients. Diabetes can result in many different diseases and often patients require extensive education from physicians and other health care providers. The purpose of this project was to develop a standardized educational pamphlet on diabetic foot help to insure complete but efficient education in the hopes to increase the number of patients who receive education. For two weeks I surveyed the clinic and counted the number of diabetic patients present for an annual well visit or six month checkup who were diabetic and if they received foot education. Then after development of an education brochure to enhance patient education I repeated the process. From the pre-enhancement phase to the enhancement phase I saw an increase in the percent of diabetic patients that received diabetic foot health education during their visit. Many patients benefited from diabetic foot health education but the benefit was not further quantifiable in this setting, as patients were not tested on education understanding and retention. Moving forward I would consider using a measurement to determine effectiveness of education implementation to quantify the quality improvement provided by the project. Patient education has proven importance in diabetic patient health, and while a higher number of patients were educated with an outlined education program, the patient benefit cannot accurately be determined without assessing education efficacy.
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    Putting the Pieces Together of an Online Classroom with the Help of Jigsaw
    (2022) Bradley, Libby; Handler, Emma
    Purpose: Anatomy has been deemed a cornerstone course within the health sciences. Recently, there has been an increase in online courses taught at university-level, including anatomy courses. Although there has been an increase in online teaching and learning in anatomy, there is still uncertainty regarding whether academic performance, satisfaction, and perceptions are equivalent between online and in-person anatomy courses. Additionally, throughout graduate courses, traditional learning (i.e., solely lecture-focused) has begun to transition with the implementation of active learning (i.e., an approach in which students are asked to engage in the learning process (not solely lecture-focused)). Previous research studies have established the effects of different active learning techniques implemented within in-person graduate anatomy courses, but little research has investigated the effects of active learning techniques implemented within online graduate anatomy courses. Therefore, a pilot study was conducted within an online Medical Science master's anatomy course measuring the perceived effects that jigsaw had on students' perception and satisfaction. Methods: Jigsaw was incorporated into 5 units of an online anatomy course. Students were randomly assigned into three expert groups, which were assigned objectives to review from lecture material. Then, two students from each expert group were assigned to teaching groups. In their teaching groups, each student created a short video to teach their designated objectives to their peers. At the end of the semester, students were asked to participate in the research study by completing a post-course survey that asked questions pertaining to course perceptions and satisfaction and their experiences regarding the active learning technique. Data was collected through Qualtrics and analyzed in NCSS using Spearman's correlation coefficient and Chi-squared tests. Results: Results from the post-course survey indicated that 77.3% of students (n=21) were satisfied with jigsaw. Moreover, students that used the teaching materials that their peers created during the teaching groups portion of jigsaw were 10% more satisfied than the students that did not (p< 0.05). Additionally, a significant, positive correlation was found when asked how effective jigsaw was when learning the course material compared to the helpfulness of jigsaw (p< 0.05). Conclusion: These findings suggest that the students that actively participated in jigsaw perceived more effectiveness and satisfaction than the students that did not. Researchers are expanding on this study with the implementation of several other active learning techniques to examine the effects when comparing academic performance, perceptions, and satisfaction. While the benefits of active learning are widely known within in-person courses, there is little research on the effects of active learning within online courses. Furthermore, there is no research investigating the effects of jigsaw implementation within an online graduate anatomy course. With the help of this study and future research, a greater understanding can be found concerning how students can best learn in an online learning environment, with the implementation of active learning.
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    Unfixed Cadavers as an Adjunct to the Texas College of Osteopathic Medicine POCUS Curriculum
    (2022) Thomas, Alexander; Son, Min Ji; Jackson, Garrett; Oh, James; Terlizzese, Taylor; Banh, Debini; Burrows, Jack; Quach, Shanon; Vedantam, Rahul
    PURPOSE: Point of care ultrasound (POCUS) continues to grow in its application across all primary care settings due to its wide ranging use and high level of patient safety, especially during medical procedures and aiding in diagnostic accuracy. Advanced technological capabilities in conjunction with affordability gives handheld ultrasound devices the ability to acquire higher quality videos and real time images that are conducive for teaching. Due to these factors, many medical schools are incorporating the use of POCUS into their curricula, including the Texas College of Osteopathic Medicine (TCOM). POCUS is introduced in year 2 as a part of the SIM Lab to help promote development of clinical skills and reasoning. This is implemented via a two-part process in which, alongside systems classes, students complete Sonosim modules that teach about using POCUS on various organ systems. Students then, as part of a skills lab, are aided by student teaching assistants and faculty on proper screening technique utilizing a student volunteer. One key limitation, however, is the fact that the majority of the student volunteers are healthy medical students, which makes it harder to screen for pathology. Due to this limitation, the use of fresh, unfixed cadavers could be a useful adjunct to allow students to further sharpen their POCUS skills while simultaneously seeing pathology in real time. METHODS: A total of 27 unfixed, de-identified cadavers were scanned with a handheld Butterfly iQ+ probe. Sixteen body systems were screened: ocular, thyroid, carotid/internal jugular vein (IJV), brachial plexus, heart, kidneys, pancreas, gallbladder, liver, aorta and the inferior vena cava (IVC), femoral artery and vein, knee, popliteal vessels, uterus, scrotum, and shoulder. RESULTS: Of the 16 body systems, we were able to consistently capture anatomical and pathological images in 8. The body systems that we saw in more than 70% of the screened cadavers include: ocular, thyroid, carotid/IJV, brachial plexus, liver, knee, scrotum, and shoulder. An ultrasound-skilled physician reviewed the images obtained from the cadavers and concluded that for certain body systems the images acquired were indiscernible from anatomy obtained from live patients. Additionally, pathologies discovered in unfixed cadavers were similar to the pathologies seen in live patients. These pathologies include: vitreous detachment, thyroid nodule, liver cyst, hydrocele, and others. CONCLUSION: Ultrasound on unfixed cadavers can be a useful adjunct to the current TCOM ultrasound curriculum. Using cadavers allows room for error and cadavers often have common pathology throughout their system that are rare in healthy student volunteers. Prospective studies should include assessing more body systems and introducing procedures that parallel the current SIM lab curriculum. Additionally, creating artificial pathologies in cadaveric models should be explored to broaden the scope of application.
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    Creating a Novel 3D Printed Phantom to Simulate Ultrasound-Guided Pericardiocentesis
    (2022) Terlizzese, Taylor; Miller, Cassidy; Weindruch, Louisa
    With the growing impetus to provide increased patient safety, more programs are turning to simulation to teach invasive procedures to students. When learning ultrasound guided procedures with high complication risk, such as pericardiocentesis, learners can use models called phantoms to mimic sonographic anatomy. Phantoms allow users to practice image acquisition and needle placement in a low-stakes environment. Unfortunately, procedural phantoms are extraordinarily expensive, making training with them often inaccessible to many learners. Home-made phantoms, while economically practical, tend to lack durability and anatomical accuracy. Our goal is to design an anatomically accurate phantom that most learners can make on their own for a low-price to practice ultrasound guided pericardiocentesis. To develop a new model, we investigated previous phantoms and other novel approaches to design an anatomically correct chest cavity. The final model was created in a multistep process. In order to accurately simulate bone on sonography, the rib cage was engineered with computer aided design and 3D-printed using polylactic acid through fused deposition modeling with a 5mm thickness. The rib cage was then enclosed in a gelatin wax casing and covered with an opaque, gelatin-glycerin skin. The heart was also 3D printed using similar specifications and filled with water. The heart was then placed in a water-filled balloon in the chest cavity to allow for a drainable pericardiocentesis with visible fluid-filled ventricles. Ultimately, after much trial and error, we were successful in creating a life-like model for which students can practice ultrasound-guided pericardiocentesis. We hope this project can serve as a guide for other students who are interested in creating phantoms, both for pericardiocentesis or other procedures. Our difficulties reflect the many nuances of simulation, a growing field in medical education today. In the future, we plan to survey students and residents on their experience with our phantom. This will help us gain insight into user experience and ease of use. With this information, we hope to further fine-tune our phantom to create the best learning experience possible.
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    Radiation Exposure: Medical Student Interest and Knowledge in Interventional Radiology After Exposure to a Model Procedure Clinic
    (2022) Vedantam, Rahul; Baker, Joshua; Timmer, Benjamin
    i. Purpose To increase medical student awareness and interest in Interventional Radiology (IR) by providing a hands on procedure clinic which allowed students to operate a C-arm, flow model, and innovative IR equipment. ii. Materials and Methods Medical students at the Texas College of Osteopathic Medicine were invited to attend the clinic held in the university anatomy lab. With the help of the anatomy lab personnel, a local radiology technician, and an IR physician; we utilized a C-arm and flow model to simulate acquiring femoral vascular access, and performing catheter skills in navigating vasculature, stroke thrombectomy, and aneurysm coilings. We analyzed IR interest and understanding pre and post the skills lab using a voluntary 11 question 5-point Likert-scale questionnaire. Due to sample size limitations survey results were modified. Strongly disagree, disagree, and undecided were modified to "no" while those who answered agree or strongly agree were modified to "yes" for statistical analysis. iii. Results A total of 12 student's (OMS I - 9, OMS II - 2, OMS III - 1) completed the survey. Following the simulation the cohort of students felt more knowledgeable about the field of IR (33% vs. 75%, P = .041), more interested in pursuing a career in IR (8% vs. 58%, P = .009), better understood the procedures IR physicians perform (25% vs. 75%, P = .014), felt more confident about acquiring vascular access (8% vs. 58%, P = .009), and better understood the role of an IR physician in an interdisciplinary care team (8% vs. 33%, P = .182). iv. Conclusions Overall, the survey results showed that the IR procedure clinic improved student satisfaction following the simulation. Further, this study demonstrated the role of IR procedure clinics in boosting medical student awareness and interest in IR.
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    Preparing Physicians for Utilizing Technology in Healthcare
    (2022) Bejarano, Michael; Patterson, Rita
    Purpose: Healthcare has become increasingly reliant on technology, creating a steep learning curve for physicians seeking to implement modern technology into their clinical practice. Thus, acquiring a sound understanding of point-of-care technology is necessary to improve patient outcomes and reduce potential harm. To determine the degree to which future physicians feel prepared to welcome this increasing dependence on technology, current 3rd- and 4th-year UNTHSC medical students were surveyed before and after taking an elective course in healthcare technologies. The objective of the survey was to identify the extent of medical student knowledge of technology applications in medicine and their comfort level in applying their knowledge in clinic. Methods: A survey was conducted for medical students enrolled in the Healthcare Emerging Technologies course at UNTHSC, both prior to the course and again following course completion. The survey elicited the comfort level of students in using technology in medicine in addition to the student's belief in the applicability of various technologies in future medical practice. The technologies specified in these questions included: augmented virtual reality, 3D printing, wearable technology, mobile applications, robotics, and artificial intelligence. Survey participants were given a sliding scale of 0-100 to gauge both their comfort level in working with the specified technology as well as their belief in the applicability of the technology in medicine. The survey results for comfort level were grouped into five categories: 0-19 ("very uncomfortable"), 20-39 ("uncomfortable"), 40-59 ("neutral"), 60-79 ("comfortable"), and 80-100 ("very comfortable"). The survey responses belief in the applicability of a particular technology were also grouped into five categories: 0-19 ("strongly disagree"), 20-39 ("disagree"), 40-59 ("neutral"), 60-79 ("agree"), and 80-100 ("strongly agree"). Results: The survey population consisted of 280 medical students that completed the pre-course survey and 200 students that completed the post-course survey. Following course completion, student comfort level with technology increased with respect to the following sectors: augmented virtual reality (+141%), 3-D printing (+140%), wearable tech (+62%), mobile applications (+24%), robotics (+112%), and artificial intelligence (+154%). Student belief in the applicability of technology in healthcare increased in the following sectors as well: augmented virtual reality (+52%), 3-D printing (+17%), wearable tech (+13%), mobile applications (+5%), robotics (+11%), and artificial intelligence (+34%). Conclusion: Providing the survey to students prior to their Healthcare Emerging Technologies course assessed their perceptions of technology in medicine. Following their participation in the class, student comfort in working with these technologies in their future medical career increased dramatically. Student confidence in the applicability of technology in healthcare increased to a lesser extent - based on pre-course survey responses, many students already held strong beliefs on the utility of technology in medicine, and the knowledge they obtained from the class solidified this belief. Given the lower comfort level of students in working with medical technology, it is necessary to give students the opportunity to discover and learn the usefulness of point-of-care technologies here at UNTHSC.
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    Assessing the Utility of the Project ECHO Platform in Advancing the Knowledge, Skills and Abilities of the Healthcare Workforce to Improve the Health of Older Adults
    (2022) Ausman, Jessie; Jose, Roslin; Severance, Jennifer; Luk-Jones, Susanna; Ross, Sarah
    Purpose: The population of older adults aged 65+ years is expected to increase by 262.9% from 2010 to 2050, thus significantly straining the geriatric care and long-term care (LTC) workforces. In addition to this, the COVID-19 pandemic has exacerbated existing strains placed on these workforces. To address these issues, the University of North Texas Health Science Center (UNTHSC) Center for Older Adults partnered with the Extension for Community Health Outcomes (ECHO) Institute to develop training and education for the LTC and geriatric care workforces. Methods: UNTHSC hosted weekly Nursing Home STRONG (NHS) ECHO training sessions targeted to LTC staff and bi-weekly Geriatrics ECHO training sessions targeted to geriatric providers. Virtually delivered NHS sessions featured specialist-led didactic presentations followed by interactive breakout discussions surrounding dementia care, IPC, workforce considerations, quality improvement, and age-friendly healthcare. Geriatric ECHO sessions followed a slightly different format; specialist-led didactic presentations were generally shorter with more time devoted to case study discussions. Topics covered during the Geriatric ECHO sessions included various aspects of dementia and cognitive impairment. Participants in both the NHS and Geriatric ECHO programs completed post-session surveys to track changes in knowledge, skills, and abilities using a five-point Likert scale. NHS participants completed a single post-session survey, while Geriatric ECHO participants completed bi-weekly surveys following the completion of each didactic session. Results: Between September 2021 and November 2021, 54 unique attendees representing 35 LTC organizations from 20 counties participated in NHS ECHO sessions. Importantly, 9 of the counties (45%) reached by the NHS ECHO were rural. A total of nine, 1-hour sessions were presented with an average of 17 attendees (excluding staff/facilitators), primarily including administrators (29.6%) and nurses (29.6%). Post-session respondents (n=10) "strongly agreed" that their knowledge of approaches to meet resident healthcare needs improved (90%), their knowledge of IPC improved (80%), and their ability to care for residents improved (80%) after attending at least one session. During this same time-period, 48 unique attendees representing 21 organizations participated in Geriatric ECHO sessions. A total of four, 1-hour sessions were presented with an average of 12 attendees, primarily including physicians (35.4%) and nurses (12.5%). Post-session responses indicated that majority of respondents "strongly agreed" that the session provided practical suggestions that can be applied in their practice (66.7 - 84.2%), the didactic topic was relevant to their learning needs (74.1 - 86.4%), and the case discussion was relevant to their learning needs (70.4 - 86.4%). Conclusions: Amidst various factors that increase burden on the healthcare workforce, the Project ECHO model offers an innovative virtual platform to adequately prepare diverse healthcare workforces to care for an aging population. This model has strong potential to improve future healthcare training and quality especially due to two unique features; collaborative, discussion-based instruction and the capacity to reach diverse and rural populations. Post-session survey responses suggested that the knowledge, attitudes, and skills of ECHO participants were improved via attendance in the NHS and/or Geriatric ECHO sessions.
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    Addressing the need for interprofessionalism and bioethics training among medical students to better serve the refugee population
    (2022) Godsey, Madison; Tatapudi, Suhas
    Purpose: As the refugee population in Texas is increasing, in order to provide a patient-centered, comprehensive plan of care, medical students would be well-served to understand how to work within the legal system to address key determinants of health, especially in regards to asylum seekers. Our goal is to implement a training program at UNTHSC that would equip future physicians to better serve their patients when legal and ethical issues arise, prepare them to work in areas of public policy, and conduct research that betters the lives of our communities. As previous literature has shown, this has reciprocal benefit for law students and MPH students who gain insight into the interconnectedness of public health, medicine and law for creating robust opportunities for patient wellness and community health. In light of the recent pandemic and the many worldwide issues pertaining to public health, medicine, law, and ethics, this program will be crucial in establishing a community network of interprofessional resources and applying systems-thinking to patients who are often bereft of adequate medical care or legal assistance. Equipping future physicians here in the DFW area with experience in law, public health and bioethics is pivotal to fulfilling HSC's mission of "creating solutions for a healthier community by preparing tomorrow's patient centered physicians and scientists and advancing the continuum of medical knowledge, discovery, and osteopathic care." This project, if implemented according to stakeholders' needs, will serve as a foundation for medical professionals to play a role in policy change and advocacy, practice clinical decision-making, and bring forth advancements in healthcare. Methods: Utilizing a self-administered questionnaire, 2 cohorts of the Texas College of Osteopathic Medicine were targeted to determine interest and availability within the curriculum. One resembled the "Pre-Clinical" era of Medical School, composed of first and second year medical student responses. The other, denoting the "Clinical" era of Medical School, composed of third and fourth year medical student responses. The questionnaire was designed using the Likert scale, carrying a minimum score of 1 (Strongly Disagree) and a maximum score of 5 (Strongly Agree). Statistical analyses were performed using SPSS, to reveal unforeseen gaps in education between both eras of Medical School. Conclusions: Once a need for a new curriculum became apparent, two medical students developed a four-year medical bioethics curriculum. Interested medical students would be trained with five core courses; Philosophy of Bioethics, Medicine and Law, Introduction to Clinical Bioethics, Global Ethics, and Bioethics in Practice. Students would also have elective opportunities to become certified in Medical Evaluation Forensics, as well as conduct research in public health, policy, or bioethics. The curriculum places emphasis on learning through case studies and creates a collaboration with Texas A&M Law school to guide students in clinical decision-making with particular focus on systems-thinking and interprofessionalism construed broadly to encompass law and public policy. Through providing an intellectual space to reflect and partake in group conversations, students will mature professionally to become culturally-responsive, compassionate and innovative physicians.
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    Encore The Impact of Quarantine on Pharmacy Students' Stress Level and Mental Health: A Regional Analysis
    (2022) Nguyen, Quang; McKeefer, Haley; Garcia, Luis; Muilenberg, Katherine; White, Annesha; Howell, Crystal
    Educators and student pharmacists adapted to online curriculum during the SARS-CoV-2 pandemic. The stress from COVID-19, quarantine, and virtual learning may impact student mental health. The magnitude of this stress may differ across the US due to some regions being affected more heavily by COVID-19 than others. We hypothesized there would be regional variation in pharmacy student stress before and during quarantine. During fall of 2020, US student pharmacists were invited to partake in an anonymous 40-question survey. The validated Perceived Stress Scale (PSS-10; Cohen, 1988) was incorporated to assess stress levels prior to and during quarantine. Additional demographic, quantitative, and qualitative free responses were captured, including CDC region. Blinded researchers (HB, QN) coded free response answers into common themes of stress while lead researcher (CH) adjudicated discrepancies. Descriptive and inferential statistics were analyzed using SPSS (Version 25.0, Armonk, NY). Analyses between PSS-10 and region prior to and during quarantine were made using Cochrane's Q test and Wilcoxon Signed-Rank and Friedman post hoc tests. 488 self-reported responses were received from 7 of 10 regions. Of these, 407 were eligible for analysis. All regions except region 9 showed an increase in PSS-10 scores during quarantine compared to before quarantine (6.2 ± 12.5; p ≤ 0.001). Region 8 had the greatest magnitude (38.5%). 67% of subjects reported an increase in stress while 22% reported a decrease in stress, and 11% had no change in stress. 70 free responses were coded into five themes: mental compartmentalization (37%), learning environment (27%), technology academic isolation (14%), accessibility (13%), and personal isolation (9%). These results support our hypothesis that there is regional variation in student pharmacist stress before and during quarantine. Overall, these data suggest potential stressors of students that educators should consider in mental health outcomes.
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    Demonstration of Ultrasound Competency for Hypertrophic Cardiac Abnormalities in Pediatric Patients
    (2022) Wyszynski, Katy; Weindruch, Louisa; Krishnagiri, Amogh; Do, Tien; Terlizzese, Taylor; Holley, Bethany; Broadbent, Dallen; Biggerstaff, Matthew; Schranz, Damon
    Objectives: Hypertrophic Cardiomyopathy (HCM) is an inherited disorder characterized by thickening of the left ventricular wall. In some cases, thickening of the interventricular septum against the motion of the mitral valve leads to impedance of the left ventricular outflow tract, also known as Hypertrophic Obstructive Cardiomyopathy (HOCM). This can result in sudden cardiac death. HOCM can be considered a "silent killer" in children, especially young athletes, as its presence is often subclinical and likely goes undetected and underreported. Point of care ultrasound (POCUS) is an efficient imaging modality that can diagnose HOCM in the pediatric population. We propose that 2nd and 3rd year medical students, all of whom are novice ultrasound users, are able to correctly visualize and measure the interventricular septum in pediatric patients using hand-held portable probes. This is relevant because it highlights the potential for medical students to use POCUS as a screening tool for HOCM. Methods: To evaluate our hypothesis, a group of nine 2nd and 3rd year medical students were asked to perform cardiac ultrasounds on pediatric patients during a pre-participation school sports physical event. While the students had some experience using point of care ultrasound, all were still considered novice ultrasound users. Prior to the event, the students attended a brief cardiac ultrasound training session with faculty. Following the school physical event, the student's images were evaluated by ultrasound-trained faculty members. Using a standardized rubric, the images were graded as either adequate or inadequate. No medical decisions were made during the process and the students were not diagnosing hypertrophic cardiomyopathy or any other heart defects. Results: While we are still in the data analysis phase of our project, preliminary results suggest that medical students are capable of visualizing the interventricular septum using hand-held portable ultrasounds. We aim to have all images evaluated by faculty within the next month. Conclusion: Overall, our project aims to show that medical students can effectively operate hand-held ultrasounds and identify the structures involved in hypertrophic cardiomyopathy. We hope to show that with minimal ultrasound training, both clinical and pre-clinical medical students can obtain cardiac ultrasound images. Our research further highlights the growing importance of point of care ultrasound and its future applications as a potential screening tool for HCM/HOCM during the physical exam.