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    Role of Service Learning in Medical Students’ Clinical and Professionalism Competencies (2016)
    (2016-03-23) Dolan, Kathryn J.
    The role of service learning in students’ acquisition of knowledge, skills and professional attitudes is poorly understood. Osteopathic medical students perform service during the first two years as one of the required elements of their ‘doctoring’ course. The availability of this data provides the first opportunity to more systematically examine the role of service learning in students’ acquisition of clinical skills and professional attitudes. Self-report data from osteopathic medical students’ required service is required for each activity or event and is now collected electronically. Starting in Fall 2015 semester, this data is now collected electronically. Data includes the type of service, and Likert scale ratings of students overall satisfaction with the experience, and the extent to which each activity meets certain learning objectives and promotes professional values such as service, integrity, respect and collaboration. Data from 458 students with a total of 1569 service learning evaluation reports are available for preliminary analysis. The most common type of service is assisting at indigent clinics, n=498 events, followed by health fairs n= 310, sporting events=203, health education and safety for children n=154 and direct health services including OMM n=120. 65.0% of students strongly agreed and 31.8% agreed the overall experience of a specific event was good for of them. 89.7% strongly agreed health career promotions was an overall good experience, followed by 88.7% for homeless services and 83.3% for school and sports physicals. 94.3% strongly agreed clinical skills objectives were met during homeless services events and 81.3% for school and sports physicals. Basic descriptive statistics facilitate understanding of students’ attitudes toward various types of service activities and generate additional hypotheses regarding satisfaction, learning objectives and professional values. Service learning is designed to provide opportunities to engage in experiential learning which is task and problem specific, improve clinical skills, and experience the benefits of altruistic behavior. The model of learning applied here originated with John Dewey (1938) and more recent elaborations by Kolb (1984) and Boyatzis (2000) who addresses issues of emotional intelligence in professional competencies. This is a step in understanding on the impact of service learning in meeting specific l objectives in medical education.
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    Humeral Head Intraosseous Access: Filling the Military Training Gap
    (2016-03-23) Sotomayor, Teresita; Hill, Brian; Maraj, Crystal; Stadler, Edward; Mott, Jeffrey
    Purpose: Traumatic life-threatening injuries often require immediate intravenous access for the delivery of lifesaving fluids and medications. When intravenous access is difficult or impossible to achieve, alternate methods of fluid and medication administration are essential. One method is intraosseous infusion, which is the process of delivering fluids directly into the bone marrow space to provide non-collapsible entry into the circulatory system. Although the U.S. Army has spearheaded the initiative of treating wounded service members on the battlefield by using the humeral head needle, it is at a disadvantage by not having a realistic human anatomical model to train on the device. Military medical providers use live tissue models in the absence of a realistic simulations trainer. Despite the limitations of anatomical variations of live tissue, the U.S. Army weighed the risks and benefits of fielding the humeral head intraosseous needle and placed them into the medical equipment sets worldwide in 2015. Description: The U.S. Army Research Laboratory assessed the scientific and technical feasibility of using a low-cost medical simulator for training military medical personnel and developed a Partial Task Trainer to train the procedure. The research involved performing a comprehensive requirements analysis, identifying current gaps in training and prioritizing capabilities. Results: The research team followed a user centric structured system engineering approach allowing for collaboration between stake holders and the development team to facilitate transitioning the technology. Military and civilian subject matter experts identified training gaps. Research was conducted to define technology requirements that would support training. After conceptual design and prototype development, usability evaluations were conducted at various stages of development to refine the final prototype. Conclusions: Usability evaluations and subject matter expertise support the continuation of phase II prototype production of a partial task trainer for the insertion of a humeral head intraosseous needle.
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    Assessment of health literacy and potential barriers regarding Human Papillomavirus (HPV) and the HPV vaccine among parents/guardians
    (2016-03-23) Fernando, Shane; Habiba, Nusrath; Magie, Richard; Bui, Priya; Rovner, Grace
    Purpose: As the number of epidemics that are currently threatening the health of Americans and the associated health consequences continue to grow, protecting future generations from sexually infected viruses has become a concern. With the recent release of Human Papillomavirus (HPV) vaccines, children have the chance to be protected from some of the more common and symptomatic types of the virus. However, vaccine uptake has remained low, leaving many children and adolescents at risk for contracting HPV once they become sexually active. This research study aims at increasing the uptake of the HPV vaccine by identifying potential barriers in completing the three-dose regimen. Information gained will provide the basis for developing a new health literacy intervention within the department of Pediatrics at UNT Health Science Center (UNTHSC). Methods: Parents/guardians of pediatric patients at the department of Pediatrics at UNTHSC will be asked to participate in the study. There are two parts to this study: the initial interview used to establish a baseline, and a follow-up interview to estimate efficacy of the health literacy intervention. The multiple choice questionnaire evaluates the parent’s/guardian’s general perception of vaccinations, knowledge of HPV and the HPV vaccine, and potential obstacles that parents may face when obtaining immunizations for their child. After the initial interview, there will be a short 5 to 10 minute education session about HPV and the HPV vaccine, and the parent/guardian will be given a handout to take home. Additionally, a different questionnaire will be given to pediatricians to help assess their thoughts and perceptions behind the low uptake of the HPV vaccine among adolescents and recommendations of better ways to improve uptake of the vaccine. Projected goals/findings: The goal is to increase parent/guardian understanding about HPV and the HPV vaccine and to determine barriers to receiving the vaccination. By assessing parent/guardian retention of the information regarding HPV and the HPV vaccine and changes in their perception and/or opinions about HPV and the HPV vaccine, this project will gauge the effectiveness of the education session and handout method. If parents/guardians are made aware of HPV and the HPV vaccine, we predict that more children would receive the vaccine and complete all three doses of the vaccine. Moreover, since the population being evaluated in this study tends to have lower levels of education and income, identifying barriers will help increase our understanding of how to get the HPV vaccine to these individuals and be affordable for them. This project is ongoing and the protocol will be adjusted according to the study results.
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    Improving Communication Skills in Orthopedic Residents: Dale Carnegie Experience
    (2016-03-23) Wagner, Russell MD; Ogunyanki, Fadeke; Chambers, Heather
    Background: Professionalism and communication skills have often been described as essential to quality patient care. In 1999, the ACGME introduced six areas of residency competency, one of which was communication skills. There have been many different approaches to implementing and improving residents’ communication skills by residency programs since that time. In this study we propose another possible approach for improving Orthopedic surgery residents’ communication skills through the Dale Carnegie Training Course. Methods: Six Orthopedic Surgery residents were randomly selected over a four-year period to attend the Dale Carnegie interpersonal communication skills training course. 360-degree (based on Clinical/Nursing/Admin Staff) and Faculty evaluations were collected for all residents, including those that did not attend the course, before and after the course. The results of the evaluations were then compared using analysis of variance (ANOVA) and analysis of covariance (ANCOVA) statistical test for continuous variables. Regression analysis was also performed to identify independent outcome predictors. P values generated with P Results: There was a statistically significant improvement in the 360-degree evaluations of residents that attended the course as compared with those that did not, p = 0.0015. There was no statistically significant improvement in faculty evaluation scores of residents that attended the course over those that did not, p= 0.1583. However, it appears that some residents that attended improved more than others, p= 0.0097, and perhaps gained more from the experience. Conclusions: Communication skills and professionalism are essential components of quality patient care and should be emphasized during medical education. The Dale Carnegie course could be considered as a possible effective tool for improving residents’ communication skills. Our study revealed a statistically significant improvement in the residents evaluations completed by nursing staff, clinic staff and other departments. This course is a time tested program with expansion to multiple franchises around the world, with consistent and reliable results. It may not be financially reasonable for residency programs to send every resident for this training, however, it might be utilized as an alternative for residents identified as “at risk” or those with noted poor communication skills by their program directors.
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    The Impact of Guided Reflection in the Professional Development of Medical Students in the Context of Death and Dying.
    (2016-03-23) Martin, Roy; Knebl, Janice; Hsu, Jennifer; Marquez-Hall, Sandra
    Statement of the Hypothesis Medical students often struggle with end-of-life issues. To address this need, two educational sessions about death and dying were introduced to fourth year medical students during their Core Geriatric Clerkship. The curriculum included the use of guided reflection, which involves facilitated discussion and reflective writing, to help students identify and cope with their feelings about death and dying. Many students had reported struggling to identify their role as a health professional related to the topic of death and dying. This study explores the impact of helping students reflect on their understanding of a medical professionals role in death and dying. Brief Summary of Materials and Methods The idea for this project originated from the results of a previous study conducted by the Reynolds Geriatric Education and Training in Texas (GET-IT) program. A pre- and post-survey was administered to fourth year students (n-805) prior to the start and again at the end of the 4 week Core Geriatric Clerkship. The survey found that students felt less comfortable discussing palliative care and end-of-life issues after exposure during the rotation (pre-test mean: 4.20, post-test mean: 3.59, p A Summary of the most pertinent, significant results As part of their core geriatrics clerkship, fourth year medical students were required to attend two sessions on end-of-life care that included lecture, guided discussion, community resources and a reflective writing assignment. The follow-up self-assessment survey greatest improvement in competency was end-of-life care. In the pre-test students had reported 1.96 average mean in their comfort level related to End of Life Care; and, after participation in the revised curriculum, students reported an average mean score of 3.02. This findings indicate that the average student now feels they have “significant ability” to talk about end-of-life issues. Conclusions derived from the presented data Fourth year medical students at UNTHSC were found to have struggled with communication related to palliative care and end-of-life issues. By providing a safe platform for review and communication on end of life issues, the study found that students reported improved confidence in the ability to cope with death and dying. While 150 minutes of instruction cannot fully prepare students to cope with these difficult and sensitive issues, students can gain confidence in this area of their professional role as future physicians. Through peer support and faculty feedback, the guided reflection increased students’ belief in their own competence, freeing them to use their unique life experiences and skills to cope with death and dying.
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    Comparing Traditional Case-Based Application and Student Question Creation Exercise on Student Performance and Perceptions
    (2016-03-23) Tatachar, Amulya PharmD; Kominski, Carol
    Objective: To compare impact of traditional case-based application exercise to student question creation exercise on a) student exam performance, b) student perceptions of enjoyment, competence, understanding, effort, interest in continuing participation and interest in subject. Methods: Subjects were 84 second-year pharmacy students in fall 2015 pharmacotherapy course. Research focus was active learning dealing with chronic kidney disease-mineral bone disorder (CKD-MBD). Students formed 12 teams with 6-7 students each. Teams were randomly assigned to either case-based or student question creation exercises using PeerWise. Four multiple choice questions related to CKD-MBD assessed student performance prior to and after participation. After completion an online survey assessed perceptions of enjoyment, competence, understanding, effort, interest in continuing participation, and interest in the subject matter. The UNTHSC Institutional Review Board approved the study protocol. Data Analysis: Two sample t tests assuming equal variances were used to compare the group experiencing student question creation with the group experiencing the case-based exercise on a) enjoyment, competence, understanding, effort, interest in continuing participation, and interest in the subject matter and b) gain scores on four multiple choice test questions administered prior to and after introduction of the subject matter. Results: Student survey responses demonstrate clearly that student question creation holds promise as an active learning tool with Pharmacy students. Two sample t tests assuming unequal variances found statistically significant differences in favor of the student question creation group on enjoyment and interest in the subject matter although other differences between the two groups on the survey questions were not significant. A two sample t test comparing the traditional case-based group to the student question creation group on gain score from pretest to posttest on the four questions related to CKD-MBD found statistically insignificant differences between the groups. Conclusions: Based upon student perceptions, student question creation has demonstrated potential as a useful learning tool. Insignificant differences on some measures of student perception as well as pretest-posttest gain scores may be due to a relatively small sample size and a very small number of test questions. The researchers expect that larger samples and repeated applications will confirm and extend positive findings in support of student question creation.