2019 CLIME FUNDED PROJECTS

USE OF VISUAL ARTS PROGRAM IN ENHANCING EMPATHY AND SELF REFLECTION AMONG PALLIATIVE CARE CLINICIANS

Lee Burnside, MD, MBA; Clinical Assistant Professor, Gerontology & Geriatric Medicine

Co-Investigator: Robert A. Pearlman, MD, MPH, Gerontology & Geriatric Medicine, University of Washington

Grant Amount: $3,588

Abstract: This pilot study aims to assess the impact of using a formal method of art observation and reflection on improving clinical skills of understanding psychosocial, spiritual, and emotional context, as well as self-care practices by University of Washington Palliative Care fellows (n-5). The ability to observe and assess the context in which a clinical situation occurs is critical in palliative medicine and is a core component of ACGME competencies in palliative care fellowship. Likewise practice in self-reflection and self-care are also cornerstones of advanced palliative care training. However, formal training in these “soft skills” is limited. We propose assessing the effect of Visual Thinking Strategies (VTS) on advancing the above skills. VTS is a formal method of programmed visual observation and reflection.3-6 We will utilize VTS in a museum setting (Seattle Frye Art Museum) with an art educator trained in VTS techniques. Quantitative and qualitative measures will be used to assess the program’s effect using validated empathy and mindfulness measures, as well as thematic assessment of participant discussions. We will also assess the programs effect on reaching ACGME milestones specific for palliative care fellowship.

NOVEL APPROACH FOR TEACHING HOW TO CONFRONT DIFFICULT CLINICAL ENCOUNTERS DEALING WITH BIAS AND DISCRIMINATION

Daniel Cabrera, MD; Clinical Assistant Professor, General Internal Medicine

Cabrera - Grant Awardee

Co-Investigators: Kali Hobson, MD – Psychiatry and Behavioral Health, Child and Adolescent Psychiatry, University of Washington, Roberto Montenegro, MD, PhD, Psychiatry and Behavioral Health, Seattle Children

Grant Amount: $5,000

Abstract: A growing awareness about the role of implicit bias in field of medicine has led to increases in a call to action. Numerous studies have shown that healthcare providers and patients carry biases that alter the provider-patient relationship and even fracture therapeutic alliances. Medical students are in a unique position as learners and experience bias and discrimination from a number of different roles. Many students witness acts of bias and discrimination from healthcare providers that are aimed at patients, healthcare providers or other learners. Students can also be the direct target of bias and discrimination from supervisors, patients and other health professionals. Medical school curriculums are including more of this content for not only students but faculty as well. However, the majority of this content is didactic in nature and provides little practical skills for how students will react and respond to episodes of bias and discrimination in their future clinical practice. This project is an initial step in building a larger curriculum that seeks to educate students and faculty on best approaches for recognizing, responding and mitigating bias and discrimination. Early content will use modalities of video content, in-person workshops, role-playing and simulation directed at students and clinical faculty at the UWSOM.

EFFECT OF A PHYSICIAN ASSISTANT STUDENT ON PRECEPTOR PRODUCTIVITY

Timothy C. Evans, MD, PhD, FACP; Associate Professor, Medical Director, MEDEX Northwest Physician Assistant Program

Co-Investigators: Keren H. Wick, PhD, Associate Professor, MEDEX Northwest-Family Medicine, University of Washington, Jennifer Erickson, PA-C, Lecturer, Tacoma Site Director, MEDEX Northwest, Family Medicine, Vanessa Bester, PA-C, Assistant Professor, Associate Director, Augsburg University Physician Assistant Program

Grant Amount: $5,000

Abstract: Guided clinical experience is a critical component of a physician assistant (PA) student’s education. However, clinical precepting is strongly perceived to have deleterious effects on productivity. This study seeks to build on a pilot project to evaluate the effect that PA students have on clinical productivity. Methods: We will recruit PA programs across the country (through the PA education association) to collect productivity data during 3 weeks of preceptor clinical practice – one week without a PA student present and 2 weeks with a PA student present (one week early in the students family medicine clinical rotation and a second week late in the rotation). Productivity is based on relative value units (RVUs) per preceptor per half-day during the 3 data collection weeks. Expected results: We expect statistically meaningful results regarding PA student effect on preceptor clinical productivity and insight into organizational and/or pedagogical features that affect productivity. These insights can be used for more successful recruitment and orientation of preceptors.

UNDERSTANDING RESIDENT EXPERIENCE IN CARING FOR DYING PATIENTS

Amy Trowbridge, MD; Acting Assistant Professor, Pediatrics, Division of Bioethics and Palliative Care, Seattle Children’s Hospital

Co-Investigators: Laura Buck, MD, Internal Medicine, Division of Palliative Care – University of Washington, Lindsay Gibbon,MD, Internal Medicine – University of Washington, Ruth Engelberg, PhD, Pulmonary, Critical Care and Sleep Medicine – University of Washington, Helene Starks, PhD, MPH, Bioethics and Humanities -University of Washington, Caroline Hurd, MD, Gerontology and Geriatric Medicine -University of Washington

Grant Amount: $3,185

Abstract: Pediatric and internal medicine residents receive little formal training in the care of a dying patient and often feel unprepared for this experience of residents caring for actively dying patients form an emotional, cultural, and hierarchical and logistical perspective. In this study, 10 UW pediatric residents and 10 UW internal medicine residents with prior experience caring for a dying patient will be recruited to participate in one-on-one semi structured interviews regarding their knowledge and skill in caring for a dying patient as well as the effect of emotional factors, cultural norms, and team roles/hierarchy on experiential learning. Interviews will be transcribed verbatim and content analyses will be conducted with deductive coding to generate thematic findings. Keys characteristics of the resident experience will be described, and pediatric and internal medicine experiences will be compared to identify universal versus specialty-specific educational concerns. Findings will inform the development of future curricula to improve resident practical knowledge, maximize opportunities for effective experiential education, and mitigate emotional distress.