scholarly journals Efficacy of Peer-Assisted Learning Across Residencies for Procedural Training in Dermatology

2011 ◽  
Vol 3 (3) ◽  
pp. 391-394 ◽  
Author(s):  
Alisa Duran-Nelson ◽  
Karyn D Baum ◽  
Anne Marie Weber-Main ◽  
Jeremiah Menk
Keyword(s):  
Internal Medicine ◽  
Primary Care Providers ◽  
Care Providers ◽  
Peer Assisted Learning ◽  
Skill Levels ◽  
Educational Value ◽  
Sum Score ◽  
Care Models ◽  
Assessment Techniques ◽  
Peer Teachers

Abstract Background With new care models such as the medical home, there is an expanding need for primary care providers to be trained in dermatologic procedures. Yet, many internal medicine residency program graduates feel unprepared to perform these procedures. The aim of this study was to evaluate the effect of a structured peer-assisted learning approach to improve residents' knowledge and skills related to common dermatologic assessment techniques. Methods Eight medicine-dermatology resident educators, with a faculty member, facilitated dermatologic procedure workshops for 28 internal medicine and medicine-pediatrics resident learners. Learners completed preworkshop and postworkshop surveys, assessing their knowledge and skill levels as well as the efficacy of the resident educators and the educational value of the workshop as a whole. Results All learners were able to properly demonstrate the techniques at the workshop's conclusion. The median sum score of self-reported knowledge increased from 3 to 9.5 (scale, 0–10; P < .001). The median sum score of self-reported skills increased from 10 to 16 (scale, 4–20; P < .001). Resident educators were favorably evaluated by their peers, and 96% of participants rated the experience as being of high educational value. Conclusion Peer-assisted learning is effective in teaching dermatologic procedures in graduate medical education. Resident learners found peer-assisted learning to be beneficial and rated their peer teachers highly. Further studies should focus on outcomes in practice, looking at the number of dermatologic procedures performed by learners, as well as the effects on resident educators.

Lessons Learned from Designing and Leading Multidisciplinary Diabetes Educational Groups

2014 ◽  
Vol 36 (2) ◽  
pp. 160-172 ◽  
Author(s):  
Bethany Glueck ◽  
Brett Foreman
Keyword(s):  
Diabetes Care ◽  
Well Being ◽  
Primary Care Providers ◽  
Health Condition ◽  
Lessons Learned ◽  
Care Providers ◽  
Care Models ◽  
Educational Groups ◽  
Education Support ◽  
Licensed Professional Counselor

Diabetes is a serious health condition that significantly impacts physical and emotional well-being. Working with primary care providers, clinical mental health counselors have an opportunity to contribute to its efficacious treatments. Researchers and clinicians have suggested a multidisciplinary approach to diabetes care may be useful. To increase knowledge and awareness about the use of collaborative care models for diabetes care, the authors—a licensed professional counselor and a family physician—share lessons learned from their experiences designing and cofacilitating a series of multidisciplinary-led diabetes groups in 2007, 2008, and 2009. The series covered education, support, and self-management techniques related to diabetes care. All 57 participants were asked to complete a program evaluation survey. All 29 participants who did so (100%) reported having a better understanding of diabetes, and 21 (71%) reported applying what they had learned (e.g., increasing exercise and making better nutritional choices). Implications for counselors in practice and research are discussed.

scholarly journals 864. Adolescent Primary Care Provider Knowledge of HIV Pre-Exposure Prophylaxis (PrEP) and Universal Screening at a Midwest Academic Medical Center

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S523-S524
Author(s):  
Genevieve Allen ◽  
Jamie Riddell
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Family Medicine ◽  
Hiv Testing ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Care Providers ◽  
Care Providers ◽  
Academic Medical ◽  
Exposure Prophylaxis

Abstract Background HIV remains a problem for adolescents with 21% of new infections in the United States in 2018 occurring in youth. In this study we attempted to assess the knowledge of and comfort with pre-exposure prophylaxis and universal HIV testing among adolescent primary care providers affiliated with one academic medical center. Methods We conducted a survey of internal medicine/pediatrics, pediatrics, and family medicine residents and attending physicians affiliated with an academic medical center. Data collected included provider prescribing and referring habits for PrEP and information on their universal HIV testing habits. A “test your knowledge” section followed the survey which asked participants to name PrEP medications and to correctly select laboratory monitoring required for PrEP. Correct answers and prescribing resources were provided on completion of the survey. Results 138 (76%) respondents were aware that PrEP is approved for adolescents. There was no significant difference across specialties or between residents and attendings. 44.8% of respondents felt uncomfortable prescribing PrEP and two thirds had never prescribed PrEP. Reasons for not prescribing PrEP included: not seeing adolescents who qualify (n=80), not having enough training (66), confidentiality concerns (22), forgetting to address PrEP (19), and concern incidence of HIV is too low to recommend PrEP (15). Pediatricians were the least likely to test for HIV with 11% of pediatrician, 32% of internal medicine/pediatric, and 38% of family medicine respondents reported universal HIV testing for patients 15 years and older (p < 0.05). Residents were more likely to test for HIV than attendings (33.3% versus 16%, p < 0.05). 111 participants completed the “test your knowledge” section. 31.5% correctly named two approved PrEP medications. There were 183 responses to the survey (49% response rate). Conclusion Adolescent primary care providers are aware that PrEP is FDA approved for adolescents but a gap in PrEP prescribing and HIV testing persists. There remain perceptions that HIV incidence is too low to discuss PrEP and that providers are not seeing patients who qualify. Next steps include developing an institutional PrEP guideline and creating an electronic medical record order set to facilitate PrEP prescribing. Disclosures All Authors: No reported disclosures

scholarly journals A Comparison of Physicians' and Nurse Practitioners' Use of Race in Clinical Decision-Making

2019 ◽  
Vol 29 (1) ◽  
pp. 1-8
Author(s):  
Khadijah E. Abdallah ◽  
Kathleen A. Calzone ◽  
Jean F. Jenkins ◽  
Melissa E. Moss ◽  
Sherrill L. Sellers ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Decision Making ◽  
Genetic Variation ◽  
Nurse Practitioners ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Primary Care Providers ◽  
Care Providers ◽  
General Internal

Objective: The debate over use of race as a proxy for genetic risk of disease continues, but little is known about how primary care providers (nurse practitioners and general internal medicine physicians) currently use race in their clinical practice. Our study in­vestigates primary care providers’ use of race in clinical practice.Methods: Survey data from three cross-sectional parent studies were used. A total of 178 nurse practitioners (NPs) and 759 general internal medicine physicians were included. The outcome of interest was the Racial At­tributes in Clinical Evaluation (RACE) scale, which measures explicit use of race in clinical decision-making. Predictor variables included the Genetic Variation Knowledge Assessment Index (GKAI), which measures the providers’ knowledge of human genetic variation.Results: In the final multivariable model, NPs had an average RACE score that was 1.60 points higher than the physicians’ score (P=.03). The GKAI score was not significantly associated with the RACE outcome in the final model (P=.67).Conclusions: Physicians had more knowl­edge of genetic variation and used patients’ race less in the clinical decision-making process than NPs. We speculate that these differences may be related to differences in discipline-specific clinical training and approaches to clinical care. Further explora­tion of these differences is needed, including examination of physicians’ and NPs’ beliefs about race, how they use race in disease screening and treatment, and if the use of race is contributing to health care dispari­ties.Ethn Dis.2019;29(1):1-8; doi:10.18865/ ed.29.1.1.

Integrative Nursing of Older Adults Across the Continuum

2014 ◽  
pp. 367-380
Author(s):  
Linda L. Halcón ◽  
Constance Schein ◽  
Corjena Cheung
Keyword(s):  
Assisted Living ◽  
Long Term Care ◽  
Primary Care Providers ◽  
Developmental Tasks ◽  
Care Providers ◽  
Term Care ◽  
Older Adulthood ◽  
Care Models ◽  
Integrative Therapies

The use of integrative therapies continues to grow and a large percent (69%) of seniors do not discuss their use of integrative approaches with their primary care providers. Understanding the developmental tasks of older adulthood is necessary to provide holistic and integrative care. This includes understanding their journey, their understanding of health and their desired trajectory and relationships. Innovative care models are emerging that incorporate integrative approaches into the full continuum of care from home, to assisted living to long-term care.

scholarly journals eConsults and Learning Between Primary Care Providers and Specialists

2019 ◽  
Vol 51 (7) ◽  
pp. 567-573 ◽  
Author(s):  
Clare Liddy ◽  
Tala Abu-Hijleh ◽  
Justin Joschko ◽  
Douglas Archibald ◽  
Erin Keely
Keyword(s):  
Primary Care ◽  
Qualitative Content Analysis ◽  
Primary Care Providers ◽  
Free Text ◽  
Care Providers ◽  
Specialist Care ◽  
Educational Tools ◽  
Educational Value ◽  
Electronic Consultation ◽  
Poor Access

Background and Objectives: Patients in many countries face poor access to specialist care. Electronic consultation (eConsult) improves access by allowing primary care providers (PCPs) and specialists to communicate electronically. As more countries adopt eConsult services, there has been growing interest in leveraging them as educational tools. Our study aimed to assess PCPs’ perspectives on eConsult’s ability to improve collegiality between providers and serve as an educational tool. Methods: We conducted a qualitative content analysis of free-text comments left by PCPs using the Champlain BASE eConsult service based in Eastern Ontario, Canada. All responses provided between January 1, 2015 and January 31, 2017 that mentioned education or collegiality were included. Results: PCPs completed 16,712 closeout surveys during the study period, of which 3,601 (22%) included free-text comments. Of these, 223 (6%) included references to education or collegiality. Three prominent themes emerged from the data: building provider relationships, teaching incorporated into answer, and prompting further learning. Conclusions: PCPs described eConsult’s ability to foster stronger relationships with specialists, deliver responses that provided teaching in multiple areas of their practice, and support further learning that extended beyond the case at hand and into their overall practice. The Champlain BASE eConsult service has educational value for providers. Further study is underway to explore how questions and replies submitted through eConsult can be used to facilitate reflective learning and promote feedback to providers.

Lung cancer screening knowledge and beliefs among primary care providers and pulmonologists.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 191-191
Author(s):  
Katie Marsh ◽  
Mikael Anne Greenwood-Hickman ◽  
Laura Jones ◽  
M. Patricia Rivera ◽  
J. Michael Bowling ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Lung Cancer ◽  
Response Rate ◽  
Screening Program ◽  
Medical Center ◽  
Academic Medical Center ◽  
Lung Cancer Screening ◽  
Primary Care Providers ◽  
Care Providers ◽  
The Family

191 Background: In response to the National Lung Screening Trial’s findings, numerous professional organizations have published guidelines recommending annual lung cancer (LC) screening with low dose computed tomography (LDCT) for eligible patients. In the wake of these guidelines, we sought to assess LC screening practices and beliefs among providers at a large academic medical center. Methods: In 2015, we surveyed 54 physicians and 9 residents in pulmonology (27% response rate) and 86 physicians and 100 residents in family/internal medicine (39% response rate). The 23 question Qualtrics survey focused on beliefs and knowledge about LC screening recommendations, guidelines, and practices. Results: Survey respondents in both groups were mostly White non-Hispanic clinicians with a mean age of 40 (range 28-67). Pulmonology respondents were mostly male (69%) and family/internal medicine respondents were mostly female (53%). The pulmonology group was more likely than family/internal medicine to believe that LC screening is beneficial for patients (p < 0.0001) and cost effective (p = 0.02). Over 76% of the pulmonology group reported ordering a LDCT for an asymptomatic patient in the past 12 months compared to 41% in the family/internal medicine group (p = 0.012). Additionally, 76% in pulmonology were aware of the American College of Chest Physicians recommendations versus 38% in family/internal medicine (p = 0.02). The majority of both groups agreed that an electronic prompt would increase the likelihood of referring a patient for LC screening. While both groups agreed that a LC screening registry would benefit the quality of patient care (100% pulmonology; 65% family/internal medicine; p = 0.02) and make them more likely to refer patients to a LC screening program (88%; 54%; p = 0.04), a significantly larger majority of the pulmonology group held these beliefs. Conclusions: Pulmonology respondents had more knowledge of guidelines and more favorable opinions of LC screening than family/internal medicine respondents. Our findings suggest future studies should focus on educating providers about recommendations and understanding why the family/internal medicine group is less likely to refer patients for LC screening.

scholarly journals Chronic kidney disease care models in low- and middle-income countries: a systematic review

2018 ◽  
Vol 3 (2) ◽  
pp. e000728 ◽  
Author(s):  
John W Stanifer ◽  
Megan Von Isenburg ◽  
Glenn M Chertow ◽  
Shuchi Anand
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Chronic Kidney Disease ◽  
Clinical Care ◽  
Primary Care Providers ◽  
Care Providers ◽  
Middle Income ◽  
Middle Income Countries ◽  
Care Models ◽  
Kidney Function Decline

IntroductionThe number of persons with chronic kidney disease (CKD) living in low- and middle-income countries (LMIC) is increasing rapidly; yet systems built to care for them have received little attention. In order to inform the development of scalable CKD care models, we conducted a systematic review to characterise existing CKD care models in LMICs.MethodsWe searched PubMed, Embase and WHO Global Health Library databases for published reports of CKD care models from LMICs between January 2000 and 31 October 2017. We used a combination of database-specific medical subject headings and keywords for care models, CKD and LMICs as defined by the World Bank.ResultsOf 3367 retrieved articles, we reviewed the full text of 104 and identified 17 articles describing 16 programmes from 10 countries for inclusion. National efforts (n=4) focused on the prevention of end-stage renal disease through enhanced screening, public awareness campaigns and education for primary care providers. Of the 12 clinical care models, nine focused on persons with CKD and the remaining on persons at risk for CKD; a majority in the first category implemented a multidisciplinary clinic with allied health professionals or primary care providers (rather than nephrologists) in lead roles. Four clinical care models used a randomised control design allowing for assessment of programme effectiveness, but only one was assessed as having low risk for bias; all four showed significant attenuation of kidney function decline in the intervention arms.ConclusionsOverall, very few rigorous CKD care models have been reported from LMICs. While preliminary data indicate that national efforts or clinical CKD care models bolstering primary care are successful in slowing kidney function decline, limited data on regional causes of CKD to inform national campaigns, and on effectiveness and affordability of local programmes represent important challenges to scalability.

scholarly journals Expanding Telehealth Competencies in Primary Care: A Longitudinal Interdisciplinary Simulation to Train Internal Medicine Residents in Complex Patient Care

2020 ◽  
Vol 12 (6) ◽  
pp. 745-752
Author(s):  
Rachel Wong ◽  
Patricia Ng ◽  
Tracey Spinnato ◽  
Erin Taub ◽  
Amit Kaushal ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Patient Care ◽  
Primary Care Providers ◽  
Interdisciplinary Care ◽  
Care Providers ◽  
Coordinated Care ◽  
Post Intervention ◽  
Complex Patient ◽  
Internal Medicine Residents

ABSTRACT Background Despite increasing use of telehealth, there are limited published curricula training primary care providers in utilizing telehealth to deliver complex interdisciplinary care. Objective To describe and evaluate a telehealth curriculum with a longitudinal objective structured clinical examination (OSCE) to improve internal medicine residents' confidence and skills in coordinating complex interdisciplinary primary care via televisits, electronic consultation, and teleconferencing. Methods In 2019, 56 first- and third-year residents participated in a 3-part, 5-week OSCE training them to use telehealth to manage complex primary care. Learners conducted a standardized patient (SP) televisit in session 1, coordinated care via inter-visit e-messaging, and led a simulated interdisciplinary teleconference in session 2. Surveys measured confidence before session 1 (pre), post-session 1 (post-1), and post-session 2 (post-2). SP televisit checklists and investigators' assessment of e-messages evaluated residents' telehealth skills. Results Response rates were pre 100%, post-1 95% (53 of 56), and post-2 100%. Post-intervention, more residents were “confident/very confident” in adjusting their camera (33%, 95% CI 20–45 vs 85%, 95% CI 75–95, P &lt; .0001), e-messaging (pre 36%, 95% CI 24–49 vs post-2 80%, 95% CI 70–91, P &lt; .0001), and coordinating interdisciplinary care (pre 35%, 95% CI 22–47 vs post-2 84%, 95% CI 74–94, P &lt; .0001). More residents were “likely/very likely” to use telemedicine in the future (pre 56%, 95% CI 43–69, vs post-2 79%, 95% CI 68–89, P = .001). Conclusions A longitudinal, interdisciplinary telehealth simulation is feasible and can improve residents' confidence in using telemedicine to provide complex patient care.

PRECONCEPTION COUNSELING IN WOMEN WITH DIABETES BY PRIMARY CARE PROVIDERS AND PERCEIVED BARRIERS TO INITIATING THIS DISCUSSION

2020 ◽  
Vol 26 (2) ◽  
pp. 226-234
Author(s):  
Angela L. Magdaleno ◽  
Sandhya Venkataraman ◽  
Melissa Dion ◽  
Meredith Rochon ◽  
Gretchen Perilli ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Diabetes Mellitus ◽  
Primary Care ◽  
Family Medicine ◽  
Care Provider ◽  
Primary Care Provider ◽  
Primary Care Providers ◽  
Perceived Barriers ◽  
Preconception Counseling ◽  
Care Providers

Objective: To evaluate the frequency that women with diabetes mellitus seen by a primary care provider receive preconception counseling; to identify barriers to preconception counseling; and to determine differences between family medicine, internal medicine, and obstetrics and gynecology. Methods: This was a retrospective cohort study in which medical records were reviewed to determine if preconception counseling was done. An electronic survey evaluated how often preconception counseling was provided and identified perceived barriers to preconception counseling. Characteristics of those who received preconception counseling and those who did not, and survey responses between disciplines, were compared. Results: Women that met inclusion criteria: 577 (18.9% of whom received preconception counseling). A total of 88.7% of primary care providers indicated that preconception counseling was important, but only 39.2% reported that they regularly provide preconception counseling. Conclusion: Women with diabetes mellitus do not regularly receive preconception counseling by primary care providers. Lack of time and knowledge were the most commonly identified barriers to providing preconception counseling. Abbreviations: DM = diabetes mellitus; FM = family medicine; HbA1c = hemoglobin A1c; IM = internal medicine; LVHN = Lehigh Valley Health Network; Ob/Gyn = obstetrics/gynecology; PC = preconception counseling; PCP = primary care provider

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