Summary:
Adaptive expertise is the ability to transfer existing skills to novel situations, enabling physicians to reduce preventable medical errors when managing clinical scenarios not encountered in training. However, medical education curricula rarely address this learning outcome. Error Management Training (EMT) is a pedagogical method that can improve transfer of skills to new contexts. Although EMT has been shown to improve adaptive expertise in procedural skills, its impact on cognitive skills in medical training remains underexplored. To fill this gap, our study aims to demonstrate that EMT improves adaptive expertise for a cognitive skill in medical education, using head computed tomography (CT) interpretation as a model. To achieve this aim, we will conduct a multicenter, randomized controlled trial across 12 geographically diverse emergency medicine residency programs. We will deliver head CT curricula using an online radiology simulation platform and assess diagnostic accuracy to compare the effects of EMT vs Error Avoidance Training. Showing that EMT improves adaptive expertise for cognitive skills in medical training will provide foundational evidence for using EMT to shape other medical education curricula. Using errors during training to develop adaptive expertise will ultimately help physicians reduce errors during unsupervised practice.

Summary:
Emergency Medicine (EM) requires 24/7 staff coverage resulting in healthcare workers’ circadian rhythm disruptions that impair clinical and cognitive performance, physical recovery, and contribute to burnout. Multiple well-being surveys continue to highlight EM’s challenges with sleep impairment due to the nature of the specialty. Despite evidence that lifestyle strategies effectively optimize performance and recovery, EM residents have variable lifestyle choices to prepare for overnight shifts. In collaboration with the Department of Psychiatry and Behavioral Sciences and Stanford WellMD and WellPhD, this prospective RCT study will examine whether a pre-shift personalized fatigue-mitigation lifestyle coaching (PFMLC) for EM residents on overnight shifts would minimize the effects of circadian rhythm disruptions on performance and recovery compared to those who receive one-time passive information on lifestyle practices. All participants will receive lifestyle strategy materials on fatigue mitigation to improve performance. Residents’ self-reported and biometric data will inform PFMLC in the active arm. Performance and recovery from night shifts will be assessed by changes in sleep, heart rate variability, readiness/recovery, alertness, cognitive performance, and mental health using FitbitTM and validated measures. This proposal addresses the TMA priority on Collaboration and Impact and Sustainability using rigorous approaches to scholarship and innovation.

Summary:
An estimated 1% of individuals have an intellectual/developmental disability (IDD), and this population is at an increased risk of poor physical and mental health. Despite this, there is very little, if any, time in medical school devoted to educating students on how to provide care to this population. Over the past two years, Lauren Clarke and Dr. Holly Tabor have pushed to promote the inclusion of people with IDD within the medical school curriculum at Stanford, and we are looking for ways to expand current educational opportunities in this space. With this goal in mind, we propose the development of a comprehensive, open-source library of educational videos for medical and physician assistant students on topics related to providing care to individuals with IDD. These videos will be designed, produced, and filmed in partnership with individuals with IDD. The creation of an educational video library will not only ensure that recent curriculum changes at Stanford are sustainable but also assist with increasing the impact of our work, as the videos will be published and shared within the wider Medical Education community. This will help ensure that all future physicians are confident in their ability to provide care to individuals with IDD.

Summary:
The goal of this project is to expand the application of ENTRUST, an innovative serious game-based virtual patient simulation platform, to non-surgical specialties to assess clinical decision-making competence for their respective Entrustable Professional Activities (EPAs). This proposal addresses three of the four priority areas, including collaboration, rigorous approaches to scholarship or innovation, and impact and sustainability. The core project team is comprised of an interdisciplinary collaboration between surgical educators, computer programmers, user interface designer/artists, and biostatisticians. Additional lines of collaboration will be fostered with residency leadership and medical educators in other GME training programs to expand and customize the use of ENTRUST in their specialty-specific contexts. The project holds strong potential to have a lasting future impact on how EPAs are taught and assessed at Stanford and at the national level.

Summary:
The American Board of Pediatrics describes the intensive care management of patients with congenital heart disease as a core competency for pediatric cardiology and critical care fellows. However, the rapid pace of the ICU and patient acuity often leave little time for structured didactic education during a typical week of cardiac ICU (CICU) service. To date, no CICU-specific curriculum has been published, and most institutions rely on experiential learning to meet educational goals. We propose the creation of a novel, online educational curriculum for fellows to learn pediatric cardiac critical care. We will create 12 web-based interactive modules to bolster fellows’ experiential learning in the CICU and ensure exposure to core concepts in CICU care. These modules will be evaluated, both by Likert scale and by quantitative metrics about use and acquisition of knowledge, to ensure efficacy and utility. We have partnered with Phoenix Children’s Hospital, and together we anticipate a robust sample size for beta-testing of the initial modules. We plan to use these modules to educate our own fellows, but will also submit the online curriculum to the Pediatric Cardiac Intensive Care Society (PCICS) Education Committee with the ultimate goal of dissemination to multiple institutions.