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  • ISSN: 2379-0547
    Volume 4, Issue 5
    Short Communication
    Andrea Grabovac*, Erin Burrell, and Carina Elise Perel-Panar
    Objective: Given the increasing use of Mindfulness-based Interventions (MBIs) to treat psychiatric disorders, the authors sought to determine the extent and availability of training in MBIs for psychiatry trainees within the Canadian post-graduate training programs. Attitudes about the need for training, and perceived barriers to delivery were also surveyed.
    Method: Over a 9-month period, a 10-question survey was electronically sent to program directors and resident representatives of all of the 16 Canadian post-graduate training programs (n= 34). Nineteen respondents replied (56% response rate), representing 11 of the 16 Canadian programs (69%).
    Results: The program survey had a response rate of 69% (19 respondents from 11 programs). All endorsed the importance of MBI training, and 53% (n=10) indicated this was not reflected in current training. Only two programs reported sufficient training to equip residents to deliver MBIs.
    Conclusions: Current training in Canadian postgraduate psychiatry programs is unlikely to equip residents with the competency to assess for referral to MBIs. Training for developing competency in MBI delivery varies widely across programs and few have robust opportunities. Standardized competencies and clear training pathways are needed.
    Ryan T. Palmer*, Rebecca E. Rdesinski, Ari Galper, Rebecca E. Cantone, Julia Shaver, Matt Symkowick, and Frances E. Biagioli
    Introduction: Telemedicine is a rapidly growing clinical practice model. Despite telemedicine's growth, relatively few U.S. medical schools or residency programs incorporate telemedicine education into their curricula. The Telemedicine Objective Structured Clinical Exam (TeleOSCE) utilizes standardized patients in a simulated video visit scenario in order to address this training gap.
    Materials and methods: The authors measured the impact of the TeleOSCE on third-year medical students' attitudes towards, knowledge of and confidence in telemedicine from academic year 2014-2015 (third rotation) through the end of 2015-2016. During their required Family Medicine clerkship 140 students completed the TeleOSCE (active group), while 32 did not participate (control group). All participants (n=172) completed a survey both at the clerkship beginning and end. Pre and post survey responses from both active and control groups were compared.
    Results: The active group showed statistically significant improvements in the "knowledge of" and "confidence in" practicing telemedicine survey items as compared to the inactive group. There was no significant difference in the "attitudes towards" telemedicine survey items.
    Discussion and conclusions: The TeleOSCE helps fill a current clinical education gap and is an effective tool in improving clinical learners' knowledge of and confidence in telemedicine. In addition to medical students, other institutions, professions and a graduate medical education programs have successfully incorporated the TeleOSCE into resident training program. The adaptability and efficacy of the TeleOSCE can help train clinical learners of different levels and professions for the future practice of telemedicine.
    Emery Lin, Jiawei Cui, Francis Tinney, Didja Hilmara, Alexandra Falsey, and Henry Lin
    Background: Effective communication is integral to establishing the caregiver-patient-physician relationship in pediatrics to deliver high quality healthcare. Understanding the drivers of quality caregiver-physician communication can improve patient-physician interactions. The goal of this study is to identify caregiver expectations and preferences of communication in the pediatric outpatient clinical visit and to determine if there is a correlation between communication strategies and satisfaction.
    Methods: A survey assessment was administered to caregivers of new patients under 9 years old at the Children's Hospital of Philadelphia outpatient clinic. The pre-visit survey assessed caregiver preferences of on various aspects of caregiver-physician communication (Preferred KEECC). The post-visit survey assessed caregiver perception of the quality of physician communication (Perceived KEECC) and caregiver satisfaction using the patient satisfaction questionnaire-18 (PSQ-18).
    Results: Of 37 caregivers surveyed, the average Preferred KEECC score was 32.14/35compared to an average Perceived KEECC total score of 32.42. There was no statistically significant difference between Preferred KEECC and Perceived KEECC scores (p-value 0.4707). Caregivers identified the categories of 'Building a relationship' and 'Sharing Information' as key for communicating with their child's physician. The average caregiver PSQ-18 score was 4.3/5. Perceived KEECC score was correlated with the PSQ-18 score for satisfaction (R= 0.4687, p-value <0.01).
    Conclusions: There is a correlation between perceived quality of physician communication and caregiver satisfaction. This study identifies caregiver-preferred elements of patient-physician communication in the pediatric outpatient clinical setting.
    Research Article
    Diana CuyCastellanos and Beth Miller
    Culturally-appropriate dietary behavioral interventions are essential for various target populations. The one-size fits all perspective for such interventions can stunt effectiveness and lead to wasted resources when delivering these interventions in the community. Furthermore, Hispanics residing in the US suffer from disproportionate rates of obesity, diabetes, and related sugar-sweetenened beverage consumption when compared to non-Hispanic Whites, providing cause for the development and implementation of appropriate behavioral interventions. The SIPsmartER intervention is an evidence-based intervention originally developed for a rural non-Hispanic White population to decrease consumption of sugar-sweetened beverages. The current literature was reviewed to determine processes, strategies and models or frameworks used to guide dietary behavioral intervention adaptation to the Hispanic population. After identifying adaptation frameworks and strategies, we outlined and implemented procedures to adapt SIPsmarter sugar-sweetened beverage intervention to the Hispanic population. The adaptation process included a literature review, researcher expertise, translation and inclusion of cultural nuances, key informant feedback, and target population questionnaires, classes and focus groups. The purpose of this manuscript is to describe this process.
    Rebecca Andrews*, Kevin W. Chamberlin, Joseph Ingrassia, Chia-Ling Kuo, Anne Pizzi, and Jennifer Moriatis Wolf
    Background: Physicians receive minimal training regarding opioid medications. The majority of medical schools do not provide robust opioid curricula, resulting in a physician workforce undertrained in pain management.
    Objective: This article provides a brief background on opioid use for pain management and an educational instrument for physicians to aid discussions of opioid management and discontinuation.
    Methods: A workshop created for internal medicine residents reviewed the indications, risks, and benefits of opioid use. The tool, based on creative mirroring of the five stages of grief for discontinuing opioids, was practiced through group role play.
    Results: Of 56 internal medicine residents who all completed surveys (100%), 13% had received previous training on opioids. Analysis showed 96% (54/56) of trainees felt the workshop was successful at opioid education and providing a skillset for difficult conversations. The residents’ comfort with opioid therapy improved after training. Prior to training, 50% of residents felt opioids were never appropriate, which decreased to 21% post training. The surveys highlight that group teaching may not be recognized as formal training, as eight residents still identified having no training on the post-survey completion.
    Conclusions: This article describes a unique educational tool focused on a difficult clinical scenario: stopping a patient’s opioid therapy. Survey analysis illustrated that the majority of residents felt it was worthwhile and provided a new skillset for managing chronic opioid use. The instrument described here can be used by medical educators to teach trainees in any field about the complexities of opioid use and successful partnering with patients.
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