scholarly journals Improving Feedback for Hematology and Oncology Fellows Via Virtual Workshops: Sustainability Analysis

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1895-1895
Author(s):  
Sarah S Sewaralthahab ◽  
Monica Peravali ◽  
Ilana Schlam ◽  
Gene Cunningham ◽  
Calvin L Chou ◽  
...  
Keyword(s):  
Small Sample ◽  
Fellowship Program ◽  
Post Intervention ◽  
Effective Feedback ◽  
Protected Time ◽  
Constructive Feedback ◽  
Quality Feedback ◽  
Set Up ◽  
Giving Feedback

Abstract Background Effective feedback is an important tool in medical education for the learning and growth of trainees and for faculty development. It allows learners to remain on course in reaching competence in clinical, research, and interpersonal skills, yet the impact of teaching feedback during hematology-oncology training has not been studied in depth. To tackle the lack of effective constructive feedback within our hematology oncology fellowship program, we initiated a quality improvement (QI) project to identify barriers in delivering and receiving high-quality feedback in the program and to create a curriculum aimed at teaching fellows and faculty how to engage in more effective feedback conversations. In the initial phase of the pilot study, a pre-intervention survey identified the two main barriers for effective feedback in our program as discomfort in giving feedback and lack of protected time. A virtual workshop improved quality of feedback by addressing these barriers and providing tools necessary to give and receive constructive feedback. We aimed to highlight the sustainability of these interventions. Methods Utilizing the results of the pre-intervention survey, we built three 2-hour interactive virtual workshop sessions conducted through the ASCO Quality Training Program. Skills that were emphasized and practiced included appropriate set-up, low-inference observations, dialogic feedback conversations and a structured approach to reinforcing and modifying feedback. A follow up session was conducted three months later allowing for reinforcement of the skills. Post-intervention surveys were given immediately after the initial workshop and after the follow-up session. All surveys were identical employing Likert scale and open-ended questions. Weekly email reminders for protected feedback time were also set up. This project was developed through the ASH Medical Educators Institute. Results Eleven out of 15 attendees completed each of the questionnaires. At baseline, 81.8 % of the participants reported they do not have protected time to complete evaluations. This decreased to 63.6% immediately post-intervention and to 27.3% at the three-month point. Similarly, only 65.5% of the participants reported they were comfortable giving feedback prior to the workshop, increasing to 81.8% immediately after the intervention and was sustained at 81.8% at three months. Half of the participants reported that the feedback was not actionable in the initial questionnaire, decreasing to 10% post-intervention. Majority of the participants agreed that the workshop helped address barriers for effective feedback in our program. Conclusions This study showed the sustainability of positive changes, even during the COVID-19 pandemic, for giving and receiving quality feedback implemented in our fellowship program. Its outcomes are salient given that it utilizes a simple intervention that could be expanded to other training programs as feedback is a systemic problem in medicine. It also underscores the importance of formal workshops in overcoming barriers for effective feedback. Limitations of this QI study include the small sample size and single-institutional design. Our future goals include incorporating a formal yearly curriculum assigning weekly protected time for feedback to ensure these results are sustainable and reproducible with incoming fellows. Disclosures No relevant conflicts of interest to declare.

Improving feedback for hematologists and oncologists in training.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 11025-11025
Author(s):  
Ilana Schlam ◽  
Sarah Sewaralthahab ◽  
Monica Peravali ◽  
Calvin Chou ◽  
Timothy D. Gilligan ◽  
...  
Keyword(s):  
Pilot Study ◽  
Interpersonal Skills ◽  
Fellowship Program ◽  
Post Intervention ◽  
High Quality ◽  
Effective Feedback ◽  
Protected Time ◽  
Quality Feedback ◽  
Giving Feedback

11025 Background: Feedback is an integral part of the learning process, allowing learners to remain on course in reaching competence in clinical, research, and interpersonal skills. However, the impact of teaching feedback during hematology-oncology training has not been studied. We aimed to identify barriers in delivering and receiving high-quality feedback in our fellowship program and to create a curriculum aimed at teaching fellows and faculty how to engage in more effective feedback conversations. Methods: This pilot study aimed at determining and addressing perceived barriers to high-quality feedback in the hematology-oncology fellowship program. A pre-intervention questionnaire, consisting of Likert scale and open-ended questions, was administered to identify barriers to giving feedback and to assess satisfaction with the quality of feedback received in our fellowship program. The results of the baseline questionnaire were utilized to build a virtual interactive three-session workshop provided by the ASCO Quality Training Program in which the importance of feedback and methods of providing effective feedback were taught. Topics included feedback set-up, low-inference observation, and a structured approach to reinforcing and modifying feedback. One month after the intervention the participants completed a follow up questionnaire. This project was developed through the ASH Medical Educators Institute. Results: Each questionnaire was completed by 11 participants. The two main barriers to high-quality feedback identified were the discomfort with both giving and receiving feedback, and the lack of protected time. At baseline only 54% of the participants reported they were comfortable giving feedback, increasing to 81% post- intervention. Pre-intervention, 81% of participants reported they did not have protected time for feedback, decreasing to 64% after the intervention and institution of weekly protected time for feedback. Half of the participants reported that the feedback was not actionable in the initial questionnaire, decreasing to 10% post-intervention. Overall, fellows reported that their feedback was mostly focused on notes, followed by presentations and interpersonal skills. Faculty reported that most of the feedback they received was about time management and patient care. Conclusions: This pilot study helped address a major barrier to improvement and growth within our training program and confirmed that feedback skills must be taught and practiced. A 6-hour virtual workshop showed tangible results in the satisfaction with and quality of feedback given to both fellows and faculty. Our findings are salient as we completed the intervention during the COVID pandemic. Limitations of the study include its single-institutional design and sample size. A major challenge anticipated is sustainability, which will be addressed by maintaining periodic lectures and assigning protected time for feedback.

scholarly journals Impact of Weight on Symptom Burden Outcomes in Myeloproliferative Neoplasm Patients Participating in an Online Yoga Intervention

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5481-5481
Author(s):  
Ryan Eckert ◽  
Jennifer Huberty ◽  
Krisstina L. Gowin ◽  
Brenda Ginos ◽  
Heidi E. Kosiorek ◽  
...  
Keyword(s):  
Research Funding ◽  
Myeloproliferative Neoplasms ◽  
Myeloproliferative Neoplasm ◽  
Symptom Burden ◽  
Normal Weight ◽  
Small Sample ◽  
Self Report ◽  
Post Intervention ◽  
Yoga Intervention

Abstract Introduction: Polycythemia vera (PV), essential thrombocythemia (ET), and myelofibrosis (MF) are chronic, Philadelphia-negative myeloproliferative neoplasms (MPNs) that are characterized by deregulated myeloid lineage cell production, leading to a high symptom burden, including abdominal pain/discomfort from splenomegaly, fatigue, depressive symptoms, sleep disturbance, sexual problems, and pruritis, among other symptoms. Yoga interventions have been demonstrated to be efficacious for improving symptom burden in other cancer populations. Additionally weight has been shown to moderate symptom burden response in cancer patients. In MPN patients, it is unknown if weight influences symptom burden response. Therefore, the purpose of this analysis was to examine the differences at baseline and post-intervention in symptom burden between overweight and normal weight MPN patients participating in an online yoga intervention. Methods: MPN patients were asked to participate in 60 minutes of online-streamed yoga weekly for 12 weeks. Participants were asked to complete online self-report surveys administered via Qualtrics at baseline (week 0), mid-point (week 7), post-intervention (week 12), and follow-up (week 16). Survey measures included demographics, total symptom burden and fatigue (MPN Symptom Assessment Form [MPN SAF]) as well as NIH PROMIS measures of pain, anxiety, depression, sleep, and sexual function. BMI status was determined through self-report height and weight obtained in the baseline survey. For statistical analyses, BMI was dichotomized into an overweight (OW) category (BMI ≥25 kg/m2) and a normal weight (NW) category (BMI <25 kg/m2). Results: A total of 38 MPN patients completed the 12-week intervention. The majority of participants were diagnosed with either PV (n=16) or ET (n=16), with MF being less common (n=6). Median age was 56 years (range 29-72) with most participants being female (n=34). A minority were OW (n=12). At baseline, total symptom score (TSS) was descriptively higher in OW vs NW participants (mean 42.8 [SD 16.2] vs 32.7 [SD 10.9], p=0.06) with no other differences observed for PROMIS outcomes. OW participants had significantly improved TSS (p=0.002), anxiety (p=0.002), sleep (p=0.02), and vaginal discomfort (p=0.04) at the end of the intervention (week 12, Table 1). Improvements in NW participants did not reach statistical significance for any scales except sleep at week 12 (p<0.001). From baseline to follow-up (week 16), NW participants had significant improvements in TSS (p=0.003), depression (p=0.003), and sleep (p=0.007). OW participants maintained significant improvements in only sleep at week 16 (p=0.005). Conclusion: In MPN patients participating in a 12-week, online streamed yoga intervention, some differences in response to the intervention were observed between OW and NW participants. However, statistical power for definitive analysis of weight as a moderator for improvement in symptom burden was limited due to a small sample size. Considering the lack of interventions in MPN patients and the potential role that weight has on outcomes in other cancer populations, a randomized controlled trial investigating the effects of online yoga in a larger sample of MPN patients is warranted along with further investigation of effectiveness of the intervention within groups of participants by weight. Disclosures Gowin: Incyte: Membership on an entity's Board of Directors or advisory committees. Mesa:Promedior: Research Funding; Incyte: Research Funding; Ariad: Consultancy; CTI Biopharma: Research Funding; Novartis: Consultancy; Gilead: Research Funding; Galena: Consultancy; Celgene: Research Funding.

scholarly journals CFT & people with intellectual disabilities

2018 ◽  
Vol 12 (1) ◽  
pp. 44-56 ◽  
Author(s):  
Mark Hardiman ◽  
Corrina Willmoth ◽  
James J. Walsh
Keyword(s):  
Intellectual Disabilities ◽  
Small Sample ◽  
Common Humanity ◽  
Post Intervention ◽  
Content Type ◽  
Self Compassion ◽  
Depth Analysis ◽  
People With Intellectual Disabilities ◽  
Compassion Scale

Purpose The purpose of this paper is to assess the effects of compassion-focussed therapy (CFT) on anxiety in a small sample of adults with intellectual disability. Design/methodology/approach A mixed-methods design was employed. Participants (n=3) completed questionnaire measures of anxiety and self-compassion on three occasions: pre-intervention, post-intervention and, at three months follow-up. Post-intervention, they also took part in recorded interviews that were analysed using interpretive phenomenological analysis. Findings were then synthesised to develop a comprehensive understanding of their overall experience. Findings Final data synthesis revealed five themes: participant anxiety decreased (reliable for all participants); the faulty self; improved positive compassionate attitudes; increased sense of common humanity; and mindful distraction techniques. Research limitations/implications This research paper offers in-depth analysis of three participants’ experiences rather than reporting in less detail about a larger number of participants. The self-compassion scale required considerable support and reasonable adaptation to be used with these clients. Originality/value Only two other studies have explored the use of CFT with people with intellectual disabilities.

scholarly journals Assertive skills: a comparison of two group interventions with Brazilian university students

2021 ◽  
Vol 34 (1) ◽  
Author(s):  
Conceição Reis de Sousa ◽  
Ricardo da Costa Padovani
Keyword(s):  
University Students ◽  
Group Process ◽  
Irrational Beliefs ◽  
Small Sample Size ◽  
Well Being ◽  
Small Sample ◽  
Control Group ◽  
Subjective Well Being ◽  
Post Intervention

AbstractThe improvement or acquisition of socioemotional skills contributes to the academic and personal adaptation of university students. The way students think about themselves and others influence their social skills and well-being. Considering the importance of social competence for professional practice in the face of new social realities, the university must invest in programs that promote the socio-emotional development of students. This study compared the effects of interventions based on Rational Emotive Behavior Therapy and Psychoeducation on assertive skills and subjective well-being. This study involved 25 undergraduate students of a public university. The students were randomly allocated to three groups, including the Control group, and they were evaluated by means of questionnaires, inventories, scales, and written evaluation of the group process. The program consisted of 10 meetings and a 6-week follow-up. Irrational beliefs were reduced and their assertive skills’ scores increased in the post-intervention and follow-up evaluations, regardless of the group. Only verbal reports from participants indicated an increase in well-being. The students’ written reports after the end of the meetings indicate that the two forms of intervention were evaluated as promoting change by the students. One of the limitations of the study is the size of the groups. Despite the very small sample size, the study highlights that developing a set of flexible beliefs is fundamental to the exercise of assertiveness.

The Feasibility of a Cognitive Behavioural Intervention for Low Self-Esteem within a Dual Diagnosis Inpatient Population

2007 ◽  
Vol 35 (4) ◽  
pp. 403-408 ◽  
Author(s):  
Irene H. Oestrich ◽  
Stephen F. Austin ◽  
Jørn Lykke ◽  
Nicholas Tarrier
Keyword(s):  
Substance Abuse ◽  
Dual Diagnosis ◽  
Self Esteem ◽  
Small Sample ◽  
Behavioural Intervention ◽  
Post Intervention ◽  
Cognitive Behavioural ◽  
Cognitive Behavioural Intervention ◽  
Inpatient Population

Low self-esteem is a common characteristic amongst populations with schizophrenia and co-morbid substance abuse (dual diagnosis) and has been linked to increased psychopathology, substance abuse and lower social functioning. The following study built upon the promising results of Hall and Tarrier (2003) and examined the feasibility and clinical utility of a cognitive behavioural intervention for low self-esteem within a population of dual diagnosis inpatients. A small sample of dual diagnosis inpatients (N = 23) were screened during a one-month wait list period to ensure stability in presentation of low self-esteem, psychopathology and substance abuse before commencing a brief eight-session intervention for low self-esteem. Results collected post intervention showed participants displayed significant increases in levels of self-esteem and corresponding significant decreases in depressive symptoms and psychopathology associated with schizophrenia. These improvements were maintained at 3-month follow-up. Outcomes were examined in terms of identifying and implementing beneficial treatments for dual diagnosis populations within everyday psychiatric settings, a population often considered one of the most challenging to treat.

The Power of Giving Feedback: Outcomes from Implementing an Online Peer Assessment System

2014 ◽  
Vol 31 (1) ◽  
pp. 1-15 ◽  
Author(s):  
Fred Phillips
Keyword(s):  
Peer Assessment ◽  
Individual Case ◽  
Assessment System ◽  
Financial Accounting ◽  
Writing Assignments ◽  
Quality Feedback ◽  
Course Work ◽  
Case Writing ◽  
Online Peer Assessment ◽  
Giving Feedback

ABSTRACTThis paper describes an online system that facilitates peer assessment of students' course work and then uses data from individual case writing assignments in introductory financial accounting to empirically examine associations between peer assessment and case writing performance. Through this description and empirical analysis, the paper addresses the following questions: (1) Why use peer assessment? (2) How does online peer assessment work? (3) Is student peer assessment reliable? (4) What do students think of peer assessment? (5) Does student peer assessment contribute to academic performance? Three key findings from this study are that students at the sophomore level were able to generate reasonably reliable feedback for peers, they valued the experiences involved in providing peer feedback, and giving quality feedback had a more significant and enduring impact on students' accounting case analyses than did receiving quality feedback, after controlling for differences in accounting knowledge and case writing skills.

Association between multimodality measures of aortic stenosis severity and quality-of-life improvement outcomes after transcatheter aortic valve replacement

2021 ◽  
Author(s):  
Michael A Catalano ◽  
Shahryar G Saba ◽  
Bruce Rutkin ◽  
Greg Maurer ◽  
Jacinda Berg ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Computed Tomography ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Replacement ◽  
Multivariable Analysis ◽  
Calcium Score ◽  
Post Intervention ◽  
Transcatheter Aortic Valve

Abstract Aims Up to 40% of patients with aortic stenosis (AS) present with discordant grading of AS severity based on common transthoracic echocardiography (TTE) measures. Our aim was to evaluate the utility of TTE and multi-detector computed tomography (MDCT) measures in predicting symptomatic improvement in patients with AS undergoing transcatheter aortic valve replacement (TAVR). Methods and results A retrospective review of 201 TAVR patients from January 2017 to November 2018 was performed. Pre- and post-intervention quality-of-life was measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Pre-intervention measures including dimensionless index (DI), stroke volume index (SVI), mean transaortic gradient, peak transaortic velocity, indexed aortic valve area (AVA), aortic valve calcium score, and AVA based on hybrid MDCT-Doppler calculations were obtained and correlated with change in KCCQ-12 at 30-day follow-up. Among the 201 patients studied, median KCCQ-12 improved from 54.2 pre-intervention to 85.9 post-intervention. In multivariable analysis, patients with a mean gradient &gt;40 mmHg experienced significantly greater improvement in KCCQ-12 at follow-up than those with mean gradient ≤40 mmHg (28.1 vs. 16.4, P = 0.015). Patients with MDCT-Doppler-calculated AVA of ≤1.2 cm2 had greater improvements in KCCQ-12 scores than those with computed tomography-measured AVA of &gt;1.2 cm2 (23.4 vs. 14.1, P = 0.049) on univariate but not multivariable analysis. No association was detected between DI, SVI, peak velocity, calcium score, or AVA index and change in KCCQ-12. Conclusion Mean transaortic gradient is predictive of improvement in quality-of-life after TAVR. This measure of AS severity may warrant greater relative consideration when selecting the appropriateness of patients for TAVR.

scholarly journals 829 Is There an Ongoing Role For 'Telephone Triage Clinics' Post COVID-19?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
B Holmes ◽  
U Mirza ◽  
C Manning ◽  
R Cooke ◽  
R Jugdey
Keyword(s):  
Common Theme ◽  
Telephone Triage ◽  
Telephone Consultation ◽  
Face To Face ◽  
Clinician Satisfaction ◽  
Set Up ◽  
Local Protocol ◽  
Telephone Questionnaire

Abstract Introduction COVID-19 has placed unprecedented demand on services at ELHT and it has become necessary to have telephone clinics to reduce the number of face-to-face clinics. A ‘telephone triage clinic’ was set up for referrals from A&E. Our project evaluated patient and clinician satisfaction on this. Method We carried out a retrospective telephone questionnaire with patients over a one-week period during the pandemic. We focussed on overall satisfaction of the consultation and quality of communication. Consultants were also surveyed for their opinion on the clinics. Results From 30 patients, 77% said they were ‘very satisfied’ with the overall experience. 80% of patients were ‘very satisfied’ with the overall length of the telephone consultation. 50% of patients felt the clinician was only ‘adequately’ able to assess them over the telephone. The consultants were less satisfied with the overall experience of telephone consultation. A common theme was that they felt ED documentation could be improved to help inform ongoing management. Conclusions Overall, patients were satisfied with the consultations. It has been successful in minimising face to face consultations however some presentations necessitate further evaluation. We need to identify those injuries appropriate for virtual follow up and design a local protocol for these.

447 Cost-Effectiveness of a 3-Year Tele-OSA Intervention

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A177-A177
Author(s):  
Jaejin An ◽  
Dennis Hwang ◽  
Jiaxiao Shi ◽  
Amy Sawyer ◽  
Aiyu Chen ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Willingness To Pay ◽  
Incremental Cost ◽  
Economic Benefits ◽  
Small Sample ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
Group 2 ◽  
The Cost

Abstract Introduction Trial-based tele-obstructive sleep apnea (OSA) cost-effectiveness analyses have often been inconclusive due to small sample sizes and short follow-up. In this study, we report the cost-effectiveness of Tele-OSA using a larger sample from a 3-month trial that was augmented with 2.75 additional years of epidemiologic follow-up. Methods The Tele-OSA study was a 3-month randomized trial conducted in Kaiser Permanente Southern California that demonstrated improved adherence in patients receiving automated feedback messaging regarding their positive airway pressure (PAP) use when compared to usual care. At the end of the 3 months, participants in the intervention group pseudo-randomly either stopped or continued receiving messaging. This analysis included those participants who had moderate-severe OSA (Apnea Hypopnea Index &gt;=15) and compared the cost-effectiveness of 3 groups: 1) no messaging, 2) messaging for 3 months only, and 3) messaging for 3 years. Costs were derived by multiplying medical service use from electronic medical records times costs from Federal fee schedules. Effects were average nightly hours of PAP use. We report the incremental cost per incremental hour of PAP use as well as the fraction acceptable. Results We included 256 patients with moderate-severe OSA (Group 1, n=132; Group 2, n=79; Group 3, n=45). Group 2, which received the intervention for 3 months only, had the highest costs and fewest hours of use and was dominated by the other two groups. Average 1-year costs for groups 1 and 3 were $6035 (SE, $477) and $6154 (SE, $575), respectively; average nightly hours of PAP use were 3.07 (SE, 0.23) and 4.09 (SE, 0.42). Compared to no messaging, messaging for 3 years had an incremental cost ($119, p=0.86) per incremental hour of use (1.02, p=0.03) of $117. For a willingness-to-pay (WTP) of $500 per year ($1.37/night), 3-year messaging has a 70% chance of being acceptable. Conclusion Long-term Tele-OSA messaging was more effective than no messaging for PAP use outcomes but also highly likely cost-effective with an acceptable willingness-to-pay threshold. Epidemiologic evidence suggests that this greater use will yield both clinical and additional economic benefits. Support (if any) Tele-OSA study was supported by the AASM Foundation SRA Grant #: 104-SR-13

scholarly journals 1113. A Novel Means of Acquiring High Quality Feedback for Training Programs –The Program Director Ombudsperson

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S587-S587
Author(s):  
David J Riedel ◽  
Rana Malek
Keyword(s):  
Training Programs ◽  
Evaluation Process ◽  
Program Director ◽  
Additional Time ◽  
High Quality ◽  
Constructive Feedback ◽  
Quality Feedback ◽  
Program Leadership ◽  
Constructive Criticism ◽  
Academic Year

Abstract Background Trainees may not always be comfortable providing frank feedback or constructive criticism to their Program Director (PD) due to fears of negative repercussions. PDs likewise may lack the means to obtain high quality feedback from trainees, particularly among smaller training programs, e.g. fellowships. An ombudsperson is defined as an independent appointee whose task is to investigate and attempt to resolve complaints and problems. Methods The PDs from Infectious Disease (ID) and Endocrinology fellowships partnered to meet with fellows from the opposite program. Meetings were held with fellows in December and June of the academic year. Each PD started their meeting with 2 questions on a 1-10 scale: How do you rate the fellowship program? How do you rate the job the PD and program leadership are doing? Additional questions covered the fellow evaluation process, faculty feedback, education vs. service balance, and gaps in training. Additional time was allotted for fellow-raised concerns. Meeting notes were summarized anonymously and returned to the PD of the other program. Fellows were asked to complete a brief questionnaire about their experience. Results A total of 15 fellows completed the survey (6 Endocrinology, 9 ID; Table). All 15 fellows agreed that the goal of the ombudsperson review meeting (i.e. to address fellow concerns in a more confidential setting) was achieved and were comfortable sharing concerns and feedback to the ombudsperson. The majority of fellows (53%) was more comfortable sharing concerns regarding the fellowship to the ombudsperson than directly to the PD. Thirteen (87%) agreed that concerns raised during the first ombudsperson meeting were addressed by the Program in subsequent months. All fellows (100%) found it helpful that the ombudsperson was another PD and recommended that the ombudsperson review meetings should continue in the fellowship. Table. Characteristics of participants and outcomes of questions about fellowship ombudsperson program Conclusion The fellowship PD ombudsperson meeting is a novel means for soliciting constructive feedback from trainees at small training programs. Fellows were comfortable with the ombudsperson arrangement, felt the meetings achieved their goal, and recommended that the meetings continue in the future. Disclosures All Authors: No reported disclosures

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