Feedback is a critically important tool in medical education. This pilot program applies and evaluates a competency-based approach to develop residents’ skills in providing feedback to medical students. In 2018–2019, a competency-based resident feedback skills program incorporating videorecording of skills, multi-source feedback using assessment tools with validity evidence, and sequential deliberate practice was piloted in a single-center, prospective study at the University of Rochester. Study participants included eight second-year psychiatry residents and 23 third-year clerkship students. After an introduction to foundational feedback concepts in didactic sessions, residents were videorecorded providing feedback to medical students. Recordings were reviewed with a faculty member for feedback. Skills were assessed by students who had received resident feedback, residents, and faculty utilizing a tool with validity evidence. Observations were repeated a total of three times. Mean feedback scores increased from 2.70 at the first feedback observation, to 2.77 at the second feedback observation, to 2.89 at the third feedback observation (maximum 3.00 points). The differences between the first and third sessions (0.19) and second and third sessions (0.12) were statistically significant (p values were < .001 and .007, with SE of 0.4 and 0.4, respectively). The observed competency-based feedback skills training program for residents using sequential, multi-source review and feedback was feasible and effective. Direct observation is a key component of high-quality feedback, and videorecording is an efficient methodology for observations, enabling both direct observation by the assessor and opportunity for enhanced self-assessment by residents viewing themselves in the feedback encounter.

Introduction Shock is a life-threatening condition amongst hospitalized patients and requires urgent management to avoid mortality. Early exposure is vital for educational and patient safety purposes. Methods We developed a 90-minute shock day session that provided internal medicine interns with a cognitive framework for the initial diagnosis and management of shock, which they applied to two simulations. The first simulation involved a patient with septic shock, and the second involved a patient with cardiogenic shock. Critical action checklists were used to assess learners and guide structured debriefs after each simulation. Medical decision-making and communication frameworks were presented through a presession video and a chalk talk. The curriculum was evaluated using pre- and postintervention surveys to assess knowledge and confidence. Results Forty-eight interns participated in the session in 2022 and 2023. We observed an increase in the percentage of learners correctly answering a knowledge-based question regarding the amount of fluid administered to a patient in septic shock (pre: 33%, post: 62%, p < .01), as well as increases in learner-reported confidence in leading a rapid response (pre: 9%, post: 62%) and in managing undifferentiated shock (pre: 13%, post: 56%), septic shock (pre: 20%, post: 83%), cardiogenic shock (pre: 2%, post: 54%), hemorrhagic shock (pre: 20%, post: 73%), and anaphylactic shock (pre: 22%, post: 54%, all ps < .01). Discussion Employing a variety of pedagogical methods, we demonstrated that intern knowledge and confidence regarding the management of a hypotensive patient during a rapid response can be increased through participation in our curriculum.

Rapid response teams (RRTs) are critical to the timely and appropriate management of acutely decompensating patients. In the academic setting, the vital role of RRT leader is often filled by a junior resident physician who may lack the necessary medical knowledge and experience. Cognitive aids help improve guideline adherence and may support resident performance as they transition into leadership roles. This study evaluated the impact of a rapid response mobile application on intern performance during simulated rapid response events. This randomized controlled trial compared the performance of interns in two simulated rapid response scenarios with and without access to the rapid response mobile application. The scenarios included anaphylaxis and supraventricular tachycardia (SVT). Simulations were video recorded and coded by trained raters. Interns in all specialties at our institution. Outcomes included (1) time to ordering critical medications (epinephrine and adenosine), (2) overall clinical performance using a checklist-based performance measure, and (3) usability of the mobile application. Enrollment and data collection occurred between November 2022 and February 2023. Forty-four interns from 12 specialties were randomized to the intervention group (N = 22) and the control group (N = 22). Time to order critical medications was significantly reduced in the intervention group compared to control for anaphylaxis (P < 0.005) and SVT (P < 0.005). The intervention group had significantly higher performance scores compared to the control group for the anaphylaxis portion (P < 0.006). Usability scores for the rapid response toolkit were good. Access to a rapid response mobile application improved the quality of care administered by interns during two simulated rapid response scenarios as determined by a decrease in time to ordering critical medications and improved performance scores. The intervention group found the mobile application to be usable. This work adds to existing literature supporting the use of technology-based cognitive aids to improve patient care.

INTRODUCTION:Feedback is critical for resident growth and is most effective when the relationship between residents and attendings is collaborative, with shared expectations for the purpose, timing, and manner of communication for feedback. Within internal medicine, there is limited work exploring the resident and hospitalist perspectives on whether key elements are included in feedback sessions. METHODS:We surveyed internal medicine residents and supervising hospitalists at a large urban training program about their perspectives on four components of effective feedback: specificity,timeliness, respectful communication, and actionability. RESULTS:We received surveys from 130/184 internal medicine residents and 74/129 hospitalists (71% and 57% response rate, respectively). Residents and hospitalists differed in their perspectives about specificity and timeliness: 54% (70/129) of residents reported they did not receive specific feedback while 90% (65/72) of hospitalists reported they delivered specific feedback (p<0.01), and 33% (43/129) of residents compared with 82% (59/72) of hospitalists perceived feedback as timely (p<0.01). Internal medicine residents and hospitalists reported concordant rates of feedback sessions consisting of a two-way conversation (84%, 109/129; 89%, 64/72, respectively, p=0.82) and that communication was delivered in a respectful manner (95%, 122/129; 97%, 70/72, respectively, p=0.57). CONCLUSIONS:We observed discordance between internal medicine residents and supervising hospitalist perspectives on the inclusion of two critical components of feedback: specificity and timing. The hospitalist cohort reported delivering more components of effective feedback than the resident cohort reported receiving. The etiology of this discordance is likely multifactorial and requires further investigation.

BACKGROUND:In-hospital cardiac arrest (IHCA) with the return of spontaneous circulation (ROSC) is a clinical scenario associated with potentially devastating outcomes.OBJECTIVE:Inconsistencies in post-ROSC care exist and we sought to find a low cost way to decrease this variability.DESIGNS, SETTINGS, AND PARTICIPANTS:We obtained pre and post intervention metrics including percentage of IHCA with a timely electrocardiogram (ECG), arterial blood gas (ABG), physician documentation, and documentation of patient surrogate communication after ROSC.INTERVENTION:We developed and implemented a post-ROSC checklist for IHCA and measured post-ROSC clinical care delivery metrics at our hospital during a 1-year pilot period.MAIN OUTCOME AND RESULTS:After the introduction of the checklist, 83.7% of IHCA had an ECG within 1 h of ROSC, compared to a baseline of 62.8% (p = 0.01). The rate of physician documentation within 6 h of ROSC was 74.4% after introduction of the checklist, compared to a baseline of 49.5% (p < 0.01). The percentage of IHCA with ROSC that completed all four of the critical post-ROSC tasks after the introduction of the post-ROSC checklist was 51.1% as compared to 19.4% before implementation (p < 0.01).CONCLUSIONS:Our study demonstrated improved consistency in completing post-ROSC clinical tasks after the introduction of a post-ROSC checklist to our hospital. This work suggests that the implementation of a checklist can have meaningful impacts on task completion in the post-ROSC setting. Despite this, considerable inconsistencies in post-ROSC care persisted after the intervention indicating the limits of checklists in this setting. Future work is needed to identify interventions that can further improve post-ROSC processes of care.

The emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has significantly disrupted the training experience of medical students throughout the United States. The rapidly evolving situation early in 2020 resulted in considerable variability in the involvement of medical students in clinical care. The outcome was a diverse patchwork of responses with most medical schools removing students from clinical environments entirely to mitigate the spread of disease, whereas others fast-tracked their involvement into frontline staff. These solutions were initiated at a time of profound uncertainty, when the luxury of determining an ideal level of medical student involvement was unattainable. Medical student and medical educators’ reflections on the early pandemic response reveal a surreal and chaotic environment. For the students, there was a palpable tension between the fear of a new contagion and a moral and ethical sense of responsibility to help in this crisis.1Gallagher TH Schleyer AM. We Signed up for this! — Student and trainee responses to the Covid-19 pandemic.N Engl J Med. 2020; 382: 25Crossref Scopus (156) Google Scholar Medical educators wrestled with unease at trying to balance medical student safety and education simultaneously.2Sheffield JVL Paauw DS. We sent them home.The Pharos. 2020; 83: 39-41Google Scholar Despite the desire to engage in the pandemic response, the sheltered role of medical students in the early pandemic left many feeling sidelined and uninvolved in this pivotal medical moment. The development of coronavirus disease 2019 (COVID-19) vaccines coupled with masking policies in health care settings has ushered in the transition from a state of emergency to a crisis with defined risks. In this context, medical students have largely returned to their prepandemic roles in clinical settings. Despite their reintegration, the role of medical students in relation to COVID-19 is far from clear. And although their education regarding COVID-19 has been limited in formal settings, their lived experience with COVID-19 has been profound because the disease touched their families, friends, and communities while also upending their medical education. As our relationship with COVID-19 evolves, so too must our understanding of the ways we can optimize medical student education and involvement in clinical care, so they can be prepared to understand and care for patients with COVID-19. While addressing our hospital's COVID-19 response we noticed medical student leadership emerge spontaneously when given the opportunity. Our hospital had a problem: There were tens of patients admitted to the hospital who had unknown COVID-19 vaccination status. Local limitations in nursing staffing levels necessitated that any intervention aimed at screening admitted patients for COVID-19 immunization be delegated to physicians. In response, we developed the Vax the Max COVID-19 vaccine competition, a gamification of COVID-19 vaccine tasks. Medicine ward teams, made up of an attending physician, 1 senior resident, 2 interns, and 1-2 medical students, were awarded points for the completion of COVID-19 vaccine tasks. Points were awarded for administration of COVID-19 vaccines, providing counseling to vaccine hesitant patients, and confirming previous immunization. The competition was paired with an interactive vaccine hesitancy workshop that provided a framework for navigating challenging discussions surrounding COVID-19 immunization. One medical student reflected that engaging in the workshop felt like “being given permission to take a leadership role within their team” in having conversations on COVID-19 vaccine hesitancy. A trophy rotated to the team with the most points at the end of every week. At the end of their rotations, the final team points were tallied. The winning team members were awarded a certificate signed by the hospital and internal medicine residency program leadership. Vax the Max was created to engage already task-saturated interns and residents on COVID-19 vaccination with a novel gamification strategy. To our surprise, we observed that the highest performing teams in the competition were propelled by highly motivated third-year medical students. These highest performing teams reached an ideal state of patient care regarding COVID-19 vaccination screening with 100% of their patients being screened for COVID-19 vaccination status. Additionally, these teams administered a substantial number of COVID-19 vaccinations. One of the most prolific teams administered 18 COVID-19 vaccines over the course of 4 weeks. The third-year medical students driving the success of these teams developed self-directed structures and organization to obtain these results. The leadership role of these medical students resulted in increased rates of COVID-19 immunization at our hospital. The endeavor also tapped into the intrinsic motivations within the medical students to have a meaningful and concrete role in combatting this pandemic. Nationwide, hospital censuses and health care worker burnout have swelled simultaneously, leading to a quagmire in efforts to create new systems of task completion. Despite the importance of COVID-19 vaccination counseling, the congestion of clinical tasks is a barrier to having these discussions. Seeing an opportunity to make an impact, the medical students emerged to become primary advocates for inpatient vaccination counseling. COVID-19 has impacted our world so forcefully as to become a great equalizer of our traditional medical hierarchies. We have all become learners in the effort to care for patients with this novel disease. This was clearly exemplified at our hospital with the leadership displayed by our rotating medical students. Our intervention provided more than an educational opportunity for students to participate in a meaningful way in the COVID-19 response. It also enabled them to harness their passion, energy, and creativity to improve the quality of care provided to our patients. The COVID-19 pandemic is a defining pillar of all clinicians’ careers, students, and teachers alike. It is our responsibility to invite these early trainees into the discourse of pandemic care—not only to improve outcomes for our patients but also to empower the next generation of leaders in medicine.

Introduction Since being first identified in December 2019, SARS-CoV-2 has resulted in millions of illnesses and deaths worldwide. Despite the safety and availability of effective vaccines that offer protection from severe COVID-19 disease, a sizable minority of the United States population has reported COVID-19 vaccine hesitancy and remains unvaccinated.Methods We developed an interactive workshop for internal medicine residents and medical students in which a framework is utilized to aid the subtyping of COVID-19 vaccine hesitancy. Learners then interactively apply this framework through vaccine counseling in a role-playing exercise.Results The workshop increased confidence in the learner's ability to determine the COVID-19 vaccine hesitancy subtype after participation in the workshop (53% preworkshop, 81% postworkshop, p=0.01). The workshop also increased reported confidence in tailoring COVID-19 vaccine counseling after participation in the workshop (60% preworkshop, 90% postworkshop, p=0.005). These gains were also seen when participant learners were compared with nonparticipant learners for both subtyping confidence (81% postworkshop, 26% nonparticipant, p<0.0001) and confidence in providing tailored counseling (90% postworkshop, 60% nonparticipant, p=0.004). Conclusion The implementation of our workshop correlated with an increase in the reported trainee confidence related to COVID-19 vaccine counseling. This offers a promising early step in developing educational programs that build trainee skills in this domain. More work is needed to establish robust curricula to support learners in reaching patients who express COVID-19 vaccine hesitancy.

BACKGROUND:Few guidelines have focused on the care delivered after return of spontaneous circulation (ROSC). Post ROSC best practice guidelines lack clarity about important tasks to accomplish in the first hours after ROSC.OBJECTIVES AND METHODS:We conducted a retrospective cohort analysis of adults who had suffered an in hospital cardiac arrest (IHCA) with ROSC over a two-year period to determine the completion rate of critical tasks in the immediate post-ROSC period: ECG within one hour, ABG within one hour, physician documentation within six hours, and surrogate communication within six hours.RESULTS:In the 113 reviewed cases, there was significant variance between completion of all four (19.4%), three (35.3%), two (32.7%), one (20.6%) and none (1.7%) of these critical post ROSC tasks. We observed that 62.8% of IHCA with ROSC had an ECG obtained within one hour of ROSC. The rate of obtaining an ABG within one hour of ROSC was 76.9%. 49.5% of cases had physician documentation of the resuscitation within six hours of ROSC. The rate of documenting surrogate communication within six hours of ROSC was 69.9%.CONCLUSIONS:Our study demonstrated that the completion rates of critical tasks in the post ROSC setting were suboptimal within our patient cohort. This provides a baseline for the development of future best practice guidelines and clinical decision-making aids for post ROSC care after IHCA. This can lead to future research in coupling specific care tasks to post ROSC patient outcomes.

Medical EducationVolume 56, Issue 11 p. 1142-1143 REALLY GOOD STUFF An equity timeout in quality improvement medical education A. Vincent Raikhel, Corresponding Author A. Vincent Raikhel vraikhel@uw.edu orcid.org/0000-0003-1630-7106 Correspondence A. Vincent Raikhel, Department of Medicine, University of Washington School of Medicine, Chief Resident for Quality and Safety at the VA Puget Sound Healthcare System, 1660 South Columbian Way, Seattle, WA 98108 USA. Email: vraikhel@uw.eduSearch for more papers by this authorHannah Oren, Hannah OrenSearch for more papers by this authorChenwei Wu, Chenwei WuSearch for more papers by this authorAnders Chen, Anders Chen orcid.org/0000-0002-1376-0629 Search for more papers by this author A. Vincent Raikhel, Corresponding Author A. Vincent Raikhel vraikhel@uw.edu orcid.org/0000-0003-1630-7106 Correspondence A. Vincent Raikhel, Department of Medicine, University of Washington School of Medicine, Chief Resident for Quality and Safety at the VA Puget Sound Healthcare System, 1660 South Columbian Way, Seattle, WA 98108 USA. Email: vraikhel@uw.eduSearch for more papers by this authorHannah Oren, Hannah OrenSearch for more papers by this authorChenwei Wu, Chenwei WuSearch for more papers by this authorAnders Chen, Anders Chen orcid.org/0000-0002-1376-0629 Search for more papers by this author First published: 29 August 2022 https://doi.org/10.1111/medu.14930Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume56, Issue11November 2022Pages 1142-1143 RelatedInformation

The development of vaccines for SARS-CoV-2 has offered game-changing protection from severe disease and death from COVID-19. Despite efforts to vaccinate individuals in the ambulatory setting, a sizable minority of the US population remains unvaccinated for COVID-19. For unvaccinated patients, hospitalization for non-COVID-19 illness offers another opportunity for vaccination. In the summer of 2021, the authors noted that COVID-19 vaccination rate for medicine inpatients at their hospital had fallen to 5.3 vaccine doses administered per 4-week block. In response, they created Vax the Max, a gamification program of COVID-19 vaccination tasks where internal medicine resident teams were awarded points for completing these tasks. Residents were anonymously surveyed after participation. The hospital demonstrated higher rates of administering the initial COVID-19 vaccine dose and completing the vaccine series in the inpatient setting per 4-week plan-do-study-act cycle after implementation of Vax the Max (5.3 versus 8.8 doses per plan-do-study-act cycle). Among residents, 76.8% reported that Vax the Max spurred their COVID-19 task engagement, and 66% reported that a similar gamification model could be utilized for a different clinical task in the future. An increase was observed in the COVID-19 vaccination rate for medicine inpatients after launching the Vax the Max competition. This occurred in the setting of resident turnover every 4 weeks, which normally makes practice sustainment more challenging. Despite this, a high degree of engagement was produced by itinerant residents. There is potential to explore similar gamification approaches involving resident physicians in areas of quality improvement and patient safety.