Human Trafficking Education for Emergency Department Providers

Many trafficked persons receive medical care in the Emergency Department (ED); however, ED staff have historically not been educated about human trafficking. In this article, we describe interventions aimed to train ED providers on the issue of trafficking. We performed a scoping review of the existing literature and found 17 studies that describe such interventions: 14 trainings implemented in the ED, two taught at conferences for ED providers, and one assessing a state-mandated training. These studies demonstrate that even brief education can improve provider confidence in screening and treating patients that experienced trafficking. We advocate for interventions to promote a team-based approach specific to the ED setting, acknowledge the importance of survivors’ input on curriculum development, and assess outcomes using pre- and post-surveys.

Hospitalist Perceptions of Barriers to Lung Ultrasound Adoption in Diverse Hospital Environments

Despite the many advantages of lung ultrasound (LUS) in the diagnosis and management of patients with dyspnea, its adoption among hospitalists has been slow. We performed semi-structured interviews of hospitals from four diverse health systems in the United States to understand determinants of adoption within a range of clinical settings. We used the diffusion of innovation theory to guide a framework analysis of the data. Of the 27 hospitalists invited, we performed 22 interviews from four hospitals of diverse types. Median years post-residency of interviewees was 10.5 [IQR:5-15]. Four main themes emerged: (1) There are important clinical advantages to LUS despite operator dependence, (2) LUS enhances patient and clinician experience, (3) Investment of clinician time to learn and perform LUS is a barrier to adoption but yields improved efficiency for the health system and (4) Mandated training and use may be necessary to achieve broad adoption as monetary incentives are less effective. Despite the perceived benefits of LUS for patients, clinicians and health systems, a significant barrier to broad LUS adoption is the experience of time scarcity by hospitalists. Future implementation strategies should focus on changes to the clinical environment that address clinician barriers to learning and adoption of new skills.

Hospitalist Perceptions of Barriers to Lung Ultrasound Adoption in Diverse Hospital Environments

Despite the many advantages of lung ultrasound (LUS) in the diagnosis and management of patients with dyspnea, adoption among hospitalists has been slow. We performed semi-structured interviews of hospitalists from 4 diverse health systems in the US to understand determinants of adoption within a range of clinical settings. We used the Diffusion of Innovation Theory to guide a framework analysis of the data. Of 27 hospitalists invited, we performed in-terviews of 22 from 4 hospitals of diverse types. Median years post-residency of interviewees was 10.5 [IQR:5-15]. Four main themes emerged: 1) There are important clinical advantages to LUS despite operator dependence, 2) LUS enhances patient and clinician experience, 3) Investment of clinician time to learn and perform LUS is a barrier to adoption but yields improved efficiency for the health system and 4) Mandated training and use may be necessary to achieve broad adoption as monetary incentives are less effective. Despite perceived benefits of LUS for patients, clinicians and health systems, an important barrier to broad LUS adoption is the experience of time scarcity by hospitalists. Future implementation strategies should focus on changes to the clinical environment that address clinician barriers to learning and adoption of new skills.

Public Administration Training in Basic Police Academies: A 50-State Comparative Analysis

Recent controversial interactions of police with the public have become an issue of important concern for public and governmental leaders, who have openly questioned current models of police training and their effectiveness. This study is asking whether basic police academies utilize curricula that reflect the contemporary challenges of modern policing today and prepare recruits to become not only police officers but also competent and skilled, street-level bureaucrats who can provide an effective and impartial service to their increasingly diverse communities. The aim of this study is to quantify, analyze, and compare the content dedicated to the public administration domain in state-mandated basic training curricula across all 50 states. The study utilizes a mixed-methods research design with content analysis. Data were generated from 49 basic training curricula (with one state not having mandated training standards) and 17 interviews with police training officials. The result shows that despite the paradigm shift in the role of the modern-day police officer, police academies have made little to no progress in bridging the gap between the academy curriculum and the practicality of police work. On average, only 3.21% of basic training curricula are explicitly dedicated to public administration training—a training focused on public service values of fundamental importance to the practice of law enforcement. This article gives public administration scholars a voice in the national debate about the crisis in police–public relations by contributing to the literature on police training reform from a much-needed public administration lens.

Police De-Escalation Training & Education: Nationally, Provincially, and Municipally

In this critical review and social innovation narrative, the current literature on de-escalation and policing is reviewed. The following explores how services train recruits and experienced officers on de-escalation, conflict resolution, and crisis intervention skills. A limited environmental scan was completed to inquire about the number of hours dedicated to de-escalation training compared with tactical and combative training within Ontario law enforcement agencies. The environmental scan also considered how services respond to imminent mental heath crises, as some services rely on mental health professionals to respond to 911 emergencies with police officers, through the Mobile Crisis Team. Within the literature, questions are proposed about the government’s role in overseeing policing, and why there fails to be any federally or provincially mandated training and approach to mental health and de-escalation within Canadian law enforcement. The author ultimately advocates for systemic change by highlighting the priorities, values, and contradictions within Canadian police services which have been influenced by colonization and patriarchal narratives.

Office-Based Anesthesia in Oral and Maxillofacial Surgery-The American Model and Training

Anxiety and pain control has been an inherent part of the oral and maxillofacial surgeon’s (OMS’s) armamentarium. In the United States, achieving competency in anesthesia is an integral part of oral and maxillofacial surgery (OMS) training curriculum. Further, OMS’s maintain the highest of standards in their practice of anesthesia outside the operating theaters. OMS-anesthesia-team model emphasizes patient safety. This requires rigorous training and meticulous standards of practice, not only by the surgeons but by the entire supporting team of office personnel. The American Association of Oral Maxillofacial Surgeons (AAOMS) endorses several critical steps in promoting the safety of this model in OMS offices. Periodic review of parameters of care, mandated training for office team and a peer review for office anesthesia evaluation of fellow OMSs are some of the critical components. AAOMS has a simulation based training to train teams in the provision of safe anesthesia in a low risk environment. Emphasis on appropriate patient selection, impeccable advanced anesthesia monitoring, and periodic strong didactic and skills based training supports the OMS-anesthesia-team in being a valid, safe practice model of anxiety and pain control in an outpatient setting.

4197 A Landscape Analysis of CTSA websites for Clinical Research Professional Training Opportunities

OBJECTIVES/GOALS: We conducted a review of CTSA websites to understand the current landscape for CRP institutional professional development and training revealed in the CTSA hub websites. METHODS/STUDY POPULATION: We accessed and reviewed 59 currently funded CTSA hub websites for evidence of CRP training opportunities. Parameters reviewed included: 1) opportunities were specified for CRPs versus K and T trainees; 2) mandated training; 3) leveling; 4) delivery methods/resources; 5) public accessibility; 6) unique features. The website reviews informed a REDCap survey sent to the CTSA Administrators (n = 149) and the Coordinator Taskforce (n = 105) listservs to gain additional knowledge of CRP training available at the institution. A subsequent repeat review of the CTSA hub websites will be conducted to determine evolving trends. RESULTS/ANTICIPATED RESULTS: A total of 40 responded to the survey from 59 CTSA hubs. Survey results are being analyzed. Website review data are being tabulated and the subsequent review of websites will be collected in February. Those findings are pending and will include a comparison of prior findings. 42% of CRP hubs list CRP training within the CTSA hub website. Required onboarding training (beyond CITI certificates) is revealed for some hubs (15%). DISCUSSION/SIGNIFICANCE OF IMPACT: On our initial website review less than half of the CTSA hub websites list specific CRP training on their website. Many were hidden behind firewalls and could not be reviewed for content. The REDCap Survey will provide more granular descriptions of programs. Data from a second website review will be collected for comparison. Based on a preliminary re-review of sites, there is a suggestion of increasing CRP workforce development information. CTSAs are well-positioned to be a central hub for promoting educational excellence of the institutional workforce, for medical centers and in other venues where clinical research is performed.

Digital Breast Tomosynthesis: Clinical Operations

Digital breast tomosynthesis (DBT) is rapidly becoming the standard of care for breast cancer screening. Implementing DBT into practice is relatively straightforward. However, there are important elements of the transition that one must consider to facilitate this process. Understanding the Digital Imaging and Communications in Medicine (DICOM) standard for DBT, as well as how images are displayed, is critical to a successful transition. Standardization of these processes will allow easier transmission of images from facility to facility, and limit the potential for errors in interpretation. Additionally, recent changes in federal regulations will require compliance with mandated training for the radiologist, technologist, and physicist, as well as accreditation for each DBT unit. These regulations aim to ensure high-quality imaging across the country as has been previously seen with standard digital mammography. Synthesized imaging is the most recent improvement for DBT, potentially obviating the need for a simultaneous traditional digital mammogram exposure. Studies have demonstrated near equivalent performance when comparing the combination imaging of DBT and digital mammography versus DBT combined with synthetic imaging. As the quality of the synthetic images continues to improve, it is increasingly likely that it will replace the traditional mammogram. Adherence to DBT-specific parameters will enhance the physician experience and ultimately translate to increased cancer detection and fewer false positive examinations, benefiting all women who are screened for breast cancer.

Abstract 27: Implications of Legislative Efforts on Layperson CPR Education

Introduction: Although bystander CPR has been shown to increase rates of survival from out-of-hospital cardiac arrest, recent work has demonstrated low rates of layperson training across the US. In an attempt to increase layperson CPR training, states have passed legislation that mandates CPR training before high school graduation. No study has assessed the impact of this legislation on likelihood of CPR training. Objectives: We assessed whether an association existed between state mandated CPR training during high school and the likelihood of young adults being currently trained or ever trained in CPR. We hypothesized younger individuals in states with required CPR training by graduation would be more likely to be currently trained or ever trained in CPR. Methods: From 09/2015-11/2015, we conducted a nationwide cross-sectional study of the US adult population using random-digit telephone dialing (n=9,022). Data were weighted by state and assessed through univariate and multivariate analyses controlling for confounding variables. Individuals age 18-24 years old were considered “young” and healthcare workers were excluded in the analysis. Subjects in the five states whose mandatory training laws began in or before the 2013-2014 school year were considered. Results: Of the 9,022 participants, individuals were classified by whether they lived in state that mandated training (n=924) or did not (n=8,084). After accounting for confounding variables, 33% of all laypeople in states with mandated training were currently trained while 27% of laypeople in states without mandated training were currently trained (OR: 1.28, 95%CI: 1.07-1.48, p=0.01). Younger adults were 59% more likely to be currently trained in states with mandated training than in states without it (OR: 1.59, 95%CI 1.34-1.89, p<0.01). In addition, younger adults were also 48% more likely to be ever trained in states with mandated training (OR: 1.48, 95%CI: 1.02-2.10 p=0.04). Conclusion: Younger adults were more likely to be trained in states with laws mandating CPR training for high school graduation. In addition, younger adults were more likely to have ever been trained in states with laws requiring compulsory CPR training for high school graduation.