Development of entrustable professional activities for residents rotating nephrology department in a Japanese university hospital: a Delphi study

ObjectivesTraining strategies regarding entrustable professional activities (EPAs) vary from country to country; one such strategy is for residents. However, there are no reports of EPAs developed for residents who rotate to the nephrology departments. We aimed to construct such EPAs, which could be generalised to other institutions.DesignPurposive design and a modified Delphi method to build consensus.SettingThe department of nephrology in a university hospital in Aichi Prefecture, Japan.ParticipantsBased on the attainment goals used in our department, an initial list was developed within the research group. The expert panel included 25 nephrologists from our affiliate hospital. Responses were based on a 5-point method and agreement was reached if both (A) and (B) were met: (A) mean≥4 with a SD <1; (B) more than 75% of respondents rated the item 4 or more. With agreement, the item was left for the next round. This round was repeated.ResultsAn initial list of 11 items was developed; after three Delphi rounds and revisions, eight items remained that were then established as the final EPAs. These items can serve as a list of goals to be reached by residents who rotate to the department of nephrology. The results indicated that most of the experts believed residents should be able to perform tasks deemed necessary or urgent for all physicians, such as those that deal with hyperkalaemia and heart failure.ConclusionsThe concept of EPAs enabled us to develop goals and evaluation criteria for residents’ training in nephrology. This study can serve as a springboard for future discussions and contribute to the development of resident education in nephrology.

Abstract 319: A Multi-faceted Programmatic Approach Associated with Over 50% Reduction in In-hospital Mortality

Introduction: In the United States, the chance of dying in the hospital widely varies by hospital, with bottom-decile hospitals having twice the rates of risk-adjusted mortality when compared to top-decile hospitals. This suggests a need for improvement in health systems nationwide. Here, we describe the implementation of, and associated outcomes for a multi-faceted, evidence-based approach to reducing in-hospital mortality. Methods: This is a retrospective interrupted time-series conducted at a large, urban, academic health system. Specifically, we describe the implementation of the following evidence-based methods: 1) escalation of communication guidelines, 2) proactive rounding with nurse response teams, and 3) rapid response teams with dedicated staff. We then quantify the associated observed-to-expected (O:E) in-hospital mortality over a 12-year period at our main hospital, and subsequently over a 3-year period at an affiliated hospital where the same interventions were later implemented. Results: Over 12 years, 445,308 patients were discharged from our main hospital, with 3,948 (0.9%) being discharged to an acute care facility, 4,558 (1.0%) discharged to hospice, and 4,648 (1.0%) expiring in the hospital. Patients had an average age of 53.1 years (std.dev 22.8 years), with the majority being female (59.0%), non-Hispanic white (66.1%), and admitted from the outpatient setting (93.3%). From the years 2010 to 2013, there was decline in O:E mortality by 59.0% (Figure 1A). This effect was sustained from 2014-2018. At the affiliate hospital, there was a similar decline in O:E mortality after implementation of the same interventions (60.5%, Figure 1B). Conclusion: Our multi-faceted, programmatic approach was associated with over 50% reductions in in-hospital mortality that were sustained for several years after implementation, and were reproduced at an affiliated hospital.

Faculty Preferences in Clinical Education Recognition: A Survey of Faculty at 3 Institutions

Purpose: Innovative studies have created proposals for measuring productivity using Relative Value Unit (RVU) or Educational Value Unit (EVU) systems, but little attention has been given to faculty preferences for rewarding educational activity. This study assesses perceptions of educational value and reward preferences for educational involvement of faculty at 3 different hospital systems affiliated with 1 medical school. Method: A 25-question electronic survey was sent to clinical faculty across 3 distinct hospital systems affiliated with a Midwestern medical school in spring 2015. Results were analyzed using the Kruskal-Wallis test and free text comments were reviewed for common themes. Results: A total of 4325 surveys were distributed and 361/467 (77%) of the surveys opened were completed for an overall response rate of 8%. Of the respondents 55% were employed by the primary affiliate hospital. Most respondents believed some method of recognition for educational activities should be in place at their institution. Overall, clinical faculty believed their own hospital systems valued education less than the school of medicine and their departments did. Most faculty gave highest preference for academic recognition, reduction in RVU requirements, or an adoption of an EVU system. Conclusion: Most faculty preferred reduced RVU requirements, adoption of an EVU system, or some method of academic recognition to reward educational activity. Differences in results between hospital systems suggest institutional climate may influence faculty preferences.