Vicki Waters

Baylor SBIRT Medical Residency Training Program: Model Description and Initial Evaluation

ABSTRACT The Baylor College of Medicine SBIRT Medical Residency Training Program is a multilevel project that trains residents and faculty in evidenced-based screening, brief intervention, and referral to treatment (SBIRT) methods for alcohol and substance use problems. This paper describes the training program and provides initial evaluation after the first year of the project. The program was successfully incorporated into the residency curricula in family medicine, internal medicine, and psychiatry. Initial evaluations indicate a high degree of satisfaction with the program and, despite a slight decrease in satisfaction scores, participants remained satisfied with the program after 30 days. Implementation barriers, solutions, and future directions of the program are discussed.

The Ethics Workup: A Case-Based Approach To Ethical Decision-Making Instruction

&NA; Students need a moral compass to cope with the real ethical dilemmas they face from their earliest training. However, the best way to accomplish this objective is not clear, despite a mandate for such learning experiences in the standards for the accreditation of physician assistant (PA) programs. A structured Ethics Workup has been part of the Baylor College of Medicine PA Program medical ethics course since 2000. Where there is general ethical consensus the work‐up helps students develop a management plan that is ethically justified and consistent with the consensus position. For controversial cases, the work‐up teaches students how to make a well‐reasoned ethically justified argument for a particular course of action. Seven faculty‐facilitated small group sessions provide the context in which the students learn to use the work‐up as a tool for case analysis and decision making. Two case vignettes are addressed in each group session, progressing in complexity from straightforward to more challenging. Students discuss the cases, argue their views based on logic, and defend their reasons for disagreement with the priorities among the appeals. Knowledge gain and capacity to decide when faced by an ethical dilemma is measured using a multiple‐choice exam coupled with the written analysis of a case vignette using the Ethics Workup. Qualitative and quantitative feedback indicates that the Ethics Workup is a helpful tool for analyzing cases bolstered by quality small group case discussions.

Baylor Pediatric SBIRT Medical Residency Training Program: Model Description and Evaluation

BACKGROUND The Baylor College of Medicine SBIRT Medical Residency Training Program is a multilevel project that trains residents and faculty in evidenced-based screening, brief intervention, and referral to treatment methods for alcohol and substance use problems. METHODS This paper describes the training program created for pediatric residents and provides an evaluation of the program. Ninety-five first-year pediatric residents participated in the training program. They were assessed on satisfaction with the program, self-rated skills, observed competency, and implementation into clinical practice. RESULTS The program was successfully incorporated into the residency curricula in two pediatric residencies. Evaluations indicate a high degree of satisfaction with the program, self-reported improvement in SBIRT skills, observed proficiency in SBIRT skills, and utilization of SBIRT skills in clinical practice. CONCLUSIONS SBIRT skills training can be incorporated into pediatric residency training, and residents are able to learn and implement the skills in clinical practice.

Assessing health care organizations' ability to implement screening, brief intervention, and referral to treatment.

Objectives:To determine if a new measure of organizational readiness for change reflects site and staff role differences when implementing a screening, brief intervention, and referral to treatment (SBIRT) program for alcohol and drug misuse in a healthcare organization. Sample:One hundred forty-one Community Health Program (CHP) and 45 Emergency Center (EC) respondents completed the survey. Methods:Medical and ancillary staff from a Level 1 trauma hospital EC and 3 CHP clinics within a large, urban, publicly funded health-care system were asked to complete the 45-item Medical Organizational Readiness for Change (MORC) survey 5 to 7 months after the start of implementation planning. One-way ANOVAs compared the 4 sites’ responses and independent t tests compared the clinical versus administrative staff responses on 8 MORC scales. Results:There were statistically significant differences between the EC and CHP sites on Need for External Guidance, Pressure to Change, Organizational Readiness to Change, Workgroup Functioning, Work Environment, and Autonomy Support. Clinical and administrative staff differed significantly on Need for External Guidance, Pressure to Change, and Organizational Readiness to Change. When change agents used the MORC data to inform their implementation process, the results were positive. Conclusions:Among CHP sites, there were differences in organizational functioning, which were consistent with CHP implementation outcomes. The MORC scales can help planners and change agents understand their organization’s current readiness to integrate screening, brief intervention, and referral to treatment services into their medical setting.

Utilizing a substance use attitudes, practices and knowledge survey for multidisciplinary curriculum development.

Abstract Development and administration of a substance use attitudes questionnaire to social work students and clinicians, physician assistant students and practitioners, and medical interns is described.

Project-Based Learning for Physician Assistant Students: A Retrospective Assessment of the Master's Paper Project at the Baylor College of Medicine Physician Assistant Program

Background: The accreditation standards for physician assistant (PA) programs require that students be equipped to search, interpret, and apply the results of medical research to patient care, as well as maintain a critical, current, and operational knowledge of new medical findings. This mandate led to the incorporation of the masters paper project (MPP) into the curriculum of the Baylor College of Medicine PA Program. Methods: A retrospective characterization of the 425 MPP projects conducted between January 1990 and December 2007 was carried out. Results: The MPPs encompassed the basic science (6.1%), applied clinical (38.6%), and health services (55.3%) research arenas. Of the 212 faculty involved as mentors, 59 assisted with 198 (46.58%) of the research projects. The projects occurred most often in the areas of internal medicine (20.6%), family medicine (20.1%), pediatrics (18.8%), and surgery (10%). MPPs exploring aspects of PA practice doubled between 2000 and 2007. More than 90% of the MPPs were quantitative in design, involving both prospective (57.03%) and retrospective data collection, using surveys (35.3%) and chart reviews (37.0%). Of the 68 studies employing explanatory designs, cross‐sectional studies were used most often, with longitudinal follow‐up and educational interventions being the next most common. Most analyses used two to six different statistical tools with over half (57.83%) involving Students t‐test or chi‐square, and others using correlations, regression analysis, factor analysis, odds ratios, and survival curves. Conclusions: The research requirement has matured in terms of mentors involved, areas investigated (specifically those exploring aspects of PA practice), and the statistics used for data analysis.

Abstract A27: Using community theater to educate the underserved about cancer screening and prevention

Background: In an effort to engage the lay community around issues related to colorectal and cervical cancer prevention and screening, we formed the Community Network for Cancer Prevention Forum Theater Project, a three-year funded program bringing together collaborators from several disciplines. The goal of the project is to foster communication and understanding of colorectal and cervical cancer risks and prevention strategies among target populations by discovering and addressing barriers to care. This will be accomplished by using an interactive form of community theater in a campaign that addresses health disparities and inequities. Drawing on a method that creates theater in direct collaboration with the community, we are using Forum Theater as a platform for developing colorectal and cervical cancer screening messages to be communicated at performances. Experimental Procedures: As part of the project, we have trained the first group of Community Health Workers (CHWs) to implement the theater project in Spanish-speaking Hispanic communities. The training took place once a week for seven weeks, with 16 people in attendance. A faculty member from the School of Allied Health conducted the first session, which was an evidence-based cervical and colorectal cancer content session; another faculty member from the School of Allied Health attended most of the sessions not only as an expert on behavioral psychology but as a participant in the Forum Theater training. The remaining six weeks focused in depth on Forum Theater methods and techniques, such as trust exercises, improvisation, building dramatic scenes, rehearsal techniques, maintaining effective dramatic flow, and encouraging audience participation. Throughout the training, participants developed their skills for addressing barriers and myths related to cancer screening and prevention, as well as how to address these issues with community members. Once CHWs are trained, their tasks are to identify and coordinate locations for performances, encourage participation from the communities that they serve, and to facilitate the production of linguistically and culturally appropriate performances. Expected Results and Conclusions: All of the participants completed a pre-post knowledge and attitudes survey of the content session and a self-administered questionnaire at the end of the seven weeks of training. Results of the pre-post tests indicate that the content session was effective in increasing knowledge levels and improving attitudes about the efficacy of screening and prevention for underserved populations. Findings from the questionnaire, which asked about leadership confidence, skill development, self-efficacy, and satisfaction with the program, suggest that the training program provided CHWs with the necessary tools to implement a successful community theater program for cancer prevention and screening. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A27.

Emergency Medicine Physiciansʼ Opinions Regarding the Use of Physician Assistants in the Emergency Department Setting in Texas.: 50.

Results: Twenty surveys were given initially, with four patients choosing not to take the follow-up survey. The average age of the patients was 68 (range 41-86), with 10 females and 10 males participating. They were taking an average of five medications. At baseline, the patients correctly recalled 70% of the medication names, 28% of the doses, 78% of the schedules, and 88% of the indications. The control group correctly named 75% of their medications at baseline and 85% in follow-up. The experimental group recalled 66% of their medications correctly at baseline and 68% at follow-up. Data was also collected for each group at baseline and in follow-up regarding dose, schedule, and indication for use. Patients’ answers did not change from baseline to follow-up regarding how often they forget to take their medications. Females correctly recalled 92% of their medications at baseline versus 49% for the males.