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Bernal J, Cresalia N, Fuller J, Gin B, Laves E, Lupton K, Malkina A, Marmor A, Wheeler D, Williams M, van Schaik S. Comprehensive Assessment of Clinical Learning Environments to Drive Improvement: Lessons Learned from a Pilot Program. Teach Learn Med 2023; 35:565-576. [PMID: 36001491 DOI: 10.1080/10401334.2022.2110497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
Problem: Recognition of the importance of clinical learning environments (CLEs) in health professions education has led to calls to evaluate and improve the quality of such learning environments. As CLEs sit at the crossroads of education and healthcare delivery, leadership from both entities should share the responsibility and accountability for this work. Current data collection about the experience and outcomes for learners, faculty, staff, and patients tends to occur in fragmented and siloed ways, and available tools to assess clinical learning environments are limited in scope. In addition, from an organizational perspective oversight of education and patient care is often done by separate entities, and not infrequently is there a sense of competing interests. Intervention: We aimed to design and pilot a holistic approach to assessment and review of CLEs and establish whether such a formative assessment process could be used to engage stakeholders from education, departmental, and health systems leadership in improvement of CLEs. Utilizing concepts of implementation science, we planned and executed a holistic assessment process for CLEs, monitored the impact of the assessment, and reflected on the process. We focused the assessment on four pillars characterizing exemplary learning environments: 1) Environment is inclusive, promotes diversity and collaboration; 2) Focus on continuous quality improvement; 3) Alignment between work and learning; and 4) Integration of education and healthcare mission. Context: At our institution, medical trainees rotate through several different health systems, but clinical and educational leadership converge at the departmental level. We therefore focused this proof-of-concept project on two large clinical departments at our institution, centering on medical learners from undergraduate and graduate medical education. For each department, a small team of champions helped create an assessment grid based on the four pillars and identified existing quantitative evaluation data sources. Champions subsequently collected qualitative data through observations, focus groups, and interviews to fill any gaps in available quantitative data. Impact: The project teams shared reports summarizing findings and recommendations with departmental, clinical, and educational leadership. Subsequent meetings with these stakeholders led to actionable plans for improvement as well as sustained structures for collaborative work between the different stakeholder groups. Lessons Learned: This project demonstrated the feasibility and effectiveness of collating, analyzing, and sharing data from various sources in engaging different stakeholder groups to initiate actionable improvement plans. Collating quantitative data from existing resources was a powerful way to demonstrate common issues in CLEs, and qualitative data provided further detail to inform improvement initiatives. Other institutions can adapt this approach to guide assessment and quality improvement of CLEs. As a next step, we are creating a comprehensive learning environment scorecard to allow for comparison of clinical learning environment quality across institutions and over time.
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Affiliation(s)
- Joey Bernal
- Medical Education, University of California San Francisco, San Francisco, California, USA
| | - Nicole Cresalia
- Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Jessica Fuller
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Brian Gin
- Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Ellen Laves
- Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Katherine Lupton
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Anna Malkina
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Andrea Marmor
- Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Dan Wheeler
- Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Mia Williams
- Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Sandrijn van Schaik
- Medicine, University of California San Francisco, San Francisco, California, USA
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Schulmeister C, Laves E, Wong J, Walch A. Pediatric Resident Insulin Management Education (PRIME): A Single-Session Workshop Emphasizing Active Learning. MedEdPORTAL 2023; 19:11301. [PMID: 36825276 PMCID: PMC9941370 DOI: 10.15766/mep_2374-8265.11301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 11/16/2022] [Indexed: 06/18/2023]
Abstract
Introduction Insulin is a high-risk medication, and errors can lead to patient morbidity and mortality. The American Board of Pediatrics recommends that all board-certified pediatricians be able to develop an insulin management plan for patients with diabetes. A needs assessment of pediatric residents revealed low self-efficacy at developing a new subcutaneous insulin plan despite didactic instruction on the topic. Methods We created a 90-minute interactive workshop that targeted resident skills in devising subcutaneous insulin plans. Learners engaged in small-group, problem-based learning and peer teaching to promote active learning and participation. We compared self-efficacy and knowledge before and after the intervention using paired t tests and evaluated learner satisfaction. Results Twenty-eight pediatric interns participated, with 25 completing both the pre- and postworkshop surveys. The primary outcome was self-efficacy (an individual's confidence in the ability to perform a specific task in a given domain). There was a statistically significant improvement in self-efficacy at creating a new subcutaneous insulin plan ( p < .001) as well as knowledge ( p < .001) after course completion. Learners were highly satisfied with the course, with a mean overall conference quality rating of 4.8 (SD = 0.4) based on a 5-point Likert scale (1 = poor, 5 = outstanding). Discussion An interactive workshop employing active learning methods resulted in improved self-efficacy and knowledge in first-year pediatric residents. Future work is needed to determine the impact of this workshop on patient care outcomes.
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Affiliation(s)
- Caroline Schulmeister
- Clinical Fellow, Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, School of Medicine; Assistant Professor, Division of Endocrinology, Department of Pediatrics, University of California, Davis, School of Medicine
| | - Ellen Laves
- Associate Professor, Department of Pediatrics, University of California, San Francisco, School of Medicine
| | - Jenise Wong
- Associate Professor, Division of Endocrinology, Department of Pediatrics, University of California, San Francisco, School of Medicine
| | - Abby Walch
- Clinical Fellow, Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, School of Medicine
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Johng SS, Gribben V, Laves E. Visual Diagnosis: An Infant with Ulcerative Lesions of the Posterior Oropharynx. Pediatr Rev 2020; 41:e31-e33. [PMID: 32737260 DOI: 10.1542/pir.2018-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Sandy S Johng
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Valerie Gribben
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Ellen Laves
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
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Pantell MS, Hessler D, Long D, Alqassari M, Schudel C, Laves E, Velazquez DE, Amaya A, Sweeney P, Burns A, Harrison FL, Adler NE, Gottlieb LM. Effects of In-Person Navigation to Address Family Social Needs on Child Health Care Utilization: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e206445. [PMID: 32478849 PMCID: PMC7265099 DOI: 10.1001/jamanetworkopen.2020.6445] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
IMPORTANCE While many organizations endorse screening for social risk factors in clinical settings, few studies have examined the health and utilization effects of interventions to address social needs. OBJECTIVE To compare the acute care utilization effects of a written resources handout vs an in-person navigation service intervention to address social needs. DESIGN, SETTINGS, AND PARTICIPANTS In this secondary analysis of a randomized clinical trial, 1809 adult caregivers of pediatric patients seen in primary and urgent care clinics of 2 safety-net hospitals in northern California were recruited between October 13, 2013, and August 27, 2015. Each participating family was randomly assigned to an in-person navigator intervention vs active control to address the family's social needs. Analyses were conducted between February 28, 2018, and September 25, 2019. INTERVENTIONS Caregivers either received written information about relevant local resources related to social needs (active control) or met with a patient navigator focused on helping them resolve social needs (navigator intervention). After an initial in-person visit, navigation services included telephone, email, and/or in-person follow-up for up to 3 months. MAIN OUTCOME AND MEASURES Child emergency department visit or hospitalization within 12 months of study enrollment. RESULTS Among the 1300 caregivers enrolled in the study without missing follow-up data, most spoke English (878 [67.5%]) and were women (1127 [86.7%]), with a mean (SD) age of 33.0 (9.33) years. Most children were aged 0 to 5 years (779 of 1300 [59.9%]), 723 children (55.6%) had Hispanic ethnicity, and 462 children (35.5%) were in excellent health; 840 families (64.6%) were recruited from urgent care. In total, 637 families (49.0%) were randomized to the in-person navigator group and 663 (51.0%) to the active control group. There was no difference in risk of an emergency department visit between the 2 groups. Children enrolled in the in-person navigator group had a decreased risk of hospitalization within 12 months (hazard ratio, 0.59; 05% CI, 0.38-0.94; P = .03), making them 69% less likely to be hospitalized. CONCLUSIONS AND RELEVANCE In this randomized clinical trial evaluating heath care utilization effects of programs designed to address social needs among families, children enrolled in the navigation group were significantly less likely to be hospitalized after the intervention but equally likely to have an emergency department visit. These findings strengthen our understanding of the effects of addressing social needs in clinical settings as part of a comprehensive strategy to improve health and reduce health care utilization. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01939704.
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Affiliation(s)
- Matthew S. Pantell
- Department of Pediatrics, University of California, San Francisco
- Center for Health and Community, University of California, San Francisco
| | - Danielle Hessler
- Department of Family and Community Medicine, University of California, San Francisco
- Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco
| | - Dayna Long
- Center for Child and Community Health, UCSF Benioff Children’s Hospital Oakland, Oakland, California
| | - Maoya Alqassari
- UCSF Benioff Children’s Hospital Oakland, Oakland, California
| | | | - Ellen Laves
- Department of Pediatrics, University of California, San Francisco
| | - Denisse E. Velazquez
- Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco
| | - Anais Amaya
- Department of Family and Community Medicine, University of California, San Francisco
- now with Latino Community Foundation, San Francisco, California
| | - Patricia Sweeney
- School of Nursing, University of California, San Francisco
- now with Planned Parenthood Mar Monte, San Jose, California
| | - Abigail Burns
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Nancy E. Adler
- Department of Pediatrics, University of California, San Francisco
- Center for Health and Community, University of California, San Francisco
- Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco
- Department of Psychiatry, University of California, San Francisco
| | - Laura M. Gottlieb
- Center for Health and Community, University of California, San Francisco
- Department of Family and Community Medicine, University of California, San Francisco
- Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco
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Gottlieb LM, Hessler D, Long D, Laves E, Burns AR, Amaya A, Sweeney P, Schudel C, Adler NE. Effects of Social Needs Screening and In-Person Service Navigation on Child Health: A Randomized Clinical Trial. JAMA Pediatr 2016; 170:e162521. [PMID: 27599265 DOI: 10.1001/jamapediatrics.2016.2521] [Citation(s) in RCA: 256] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Social determinants of health shape both children's immediate health and their lifetime risk for disease. Increasingly, pediatric health care organizations are intervening to address family social adversity. However, little evidence is available on the effectiveness of related interventions. OBJECTIVE To evaluate the effects of social needs screening and in-person resource navigation services on social needs and child health. DESIGN, SETTING, AND PARTICIPANTS Patients were randomized to intervention or active control conditions by the day of the week. Primary outcomes observed at 4 months after enrollment included caregivers' reports of social needs and child health status. Recruitment occurred between October 13, 2013, and August 27, 2015, in pediatric primary and urgent care clinics in 2 safety-net hospitals. Participants were English-speaking or Spanish-speaking caregivers accompanying minor children to nonacute medical visits. INTERVENTIONS After standardized screening, caregivers either received written information on relevant community services (active control) or received in-person help to access services with follow-up telephone calls for further assistance if needed (navigation intervention). MAIN OUTCOMES AND MEASURES Change in reported social needs and in caregiver assessment of child's overall health reported 4 months later. RESULTS Among 1809 patients enrolled in the study, evenly split between the 2 sites, 31.6% (n = 572) were enrolled in a primary care clinic and 68.4% (n = 1237) were enrolled in an urgent care setting. The children were primarily Hispanic white individuals (50.9% [n = 921]) and non-Hispanic black individuals (26.2% [n = 473]) and had a mean (SD) age of 5.1 (4.8) years; 50.5% (n = 913) were female. The reported number of social needs at baseline ranged from 0 to 11 of 14 total possible items, with a mean (SD) of 2.7 (2.2). At 4 months after enrollment, the number of social needs reported by the intervention arm decreased more than that reported by the control arm, with a mean (SE) change of -0.39 (0.13) vs 0.22 (0.13) (P < .001). In addition, caregivers in the intervention arm reported significantly greater improvement in their child's health, with a mean (SE) change of -0.36 (0.05) vs -0.12 (0.05) (P < .001). CONCLUSIONS AND RELEVANCE To our knowledge, this investigation is the first randomized clinical trial to evaluate health outcomes of a pediatric social needs navigation program. Compared with an active control at 4 months after enrollment, the intervention significantly decreased families' reports of social needs and significantly improved children's overall health status as reported by caregivers. These findings support the feasibility and potential effect of addressing social needs in pediatric health care settings. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01939704.
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Affiliation(s)
- Laura M Gottlieb
- Department of Family and Community Medicine, University of California, San Francisco2Center for Health and Community, University of California, San Francisco
| | - Danielle Hessler
- Department of Family and Community Medicine, University of California, San Francisco
| | - Dayna Long
- Primary Care Clinic, Benioff Children's Hospital, University of California, Oakland4currently with the Center for Community Health and Engagement, Benioff Children's Hospital, University of California, Oakland
| | - Ellen Laves
- Department of Pediatrics, University of California, San Francisco
| | | | - Anais Amaya
- Department of Family and Community Medicine, University of California, San Francisco
| | - Patricia Sweeney
- student, School of Nursing, University of California, San Francisco
| | - Christine Schudel
- Primary Care Clinic, Benioff Children's Hospital, University of California, Oakland
| | - Nancy E Adler
- Center for Health and Community, University of California, San Francisco
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Schroeter G, Gluschke A, Götzky S, Huang J, Irmisch G, Laves E, Schrader O, Stier G. Oxim-Umlagerungen in der Tetralon-Reihe. ACTA ACUST UNITED AC 2006. [DOI: 10.1002/cber.19300630605] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Budding yeast possesses one myosin-II, Myo1p, whereas fission yeast has two, Myo2p and Myp2p, all of which contribute to cytokinesis. We find that chimeras consisting of Myo2p or Myp2p motor domains fused to the tail of Myo1p are fully functional in supporting budding yeast cytokinesis. Remarkably, the tail alone of budding yeast Myo1p localizes to the contractile ring, supporting both its constriction and cytokinesis. In contrast, fission yeast Myo2p and Myp2p require both the catalytic head domain as well as tail domains for function, with the tails providing distinct functions (Bezanilla and Pollard, 2000). Myo1p is the first example of a myosin whose cellular function does not require a catalytic motor domain revealing a novel mechanism of action for budding yeast myosin-II independent of actin binding and ATPase activity.
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Affiliation(s)
- Matthew Lord
- Department of Molecular, Cellular, and Developmental Biology, Yale University, New Haven, CT 06520-8103, USA
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Laves E. Dr. Rudolf Hase. Angew Chem Int Ed Engl 1906. [DOI: 10.1002/ange.19060194402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kreis H, Baldin W, Laves E, Seiler F, Heuss R, Hefelmann R, Wollny R, Zeiss C, Annacker JH, Reich E. Zur Untersuchung der Butter. Anal Bioanal Chem 1895. [DOI: 10.1007/bf01595874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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