General Medical Disciplines Department of Medicine

Seed Grant Recipients

Preetha Basaviah, MD

pbasaviahPurpose of Study: To study the difference in experimental learning vs. classroom learning in preparing students for the transition from medical school years 1 and 2 (pre-clerkship) to medical school years 3 and 4 (clerkship).

To prepare students for the transition from pre-clerkship to clerkship, medical schools have traditionally provided classroom-based sessions that may not be as optimal as “hands-on” experiences.  Recent changes in medical education have focused more on experiential learning opportunities. A 2010 systematic review by Yardley et al, found two major gaps in knowledge for early experiences for healthcare undergraduates: (1) there remains a need to understand the process of early experiences in order to predict better what learning outcomes will result from them, and (2) further study is needed to understand what is essential to make early experiences effective for specific intended outcomes.

As a first step to close these gaps, this project will measure the effect of experiential learning before clerkships on students’ efficiency and productivity in a variety of domains.  It will also address the gap in measurement of long-term effects and the impact, and relevance of such learning into the clerkship year.  We predict that when students are able to identify team-based practices in a professional group in advance, this familiarity enhances their professional identity formation and better helps them lead them to mastery of the ACGME core competencies before residency.

Jeffrey Chi, MD

jchiPurpose of Study: To study the impact that Electronic Medical Records (EMR) has on medical education.

With few exceptions, previous survey and observational studies with paper records revealed that most internal medicine trainees spent more than 4 hours per day on clinical documentation and only small fraction of time in direct patient care.  This is consistent with the estimated level of EMR use at Stanford.  It has been postulated that implementation of Electronic Health Records (EHR) has altered trainee workflow and further predisposes the learner to spend more time occupied by clerical work.  This has significant implications since the use of EHR without proper training could negatively impact adherence to work hour regulations, education and delivery of patient-centered care.  Our preliminary assessment indicates that Stanford medical students spend in excess of 6 hours per day on documentation and Stanford house officers spend in excess of 8 hours per day . We hope to contribute to the literature by characterizing EHR use by medical residents and students at our institution and examining which factors may be associated with increased use.

Errol Ozdalga, MD

Purpose of Study: To create a website that contains medical information which is practical, easy to access and relevant to what is being taught to residents and students.

The goal of this project is to make information that is taught in morning reports, noon conferences and during clinical rotations, easily accessible so that it can both be reinforced and available if needed for patient care.  Moreover, this website will possess resources for residents, students and attending physicians.  These resources (e.g. integrated paging, hospital numbers, antibiograms and much more) will be established in one centralized location and serve to save physicians and students time while promoting better study in the practice of medicine.  The pilot website is available by clicking here.

Keith Posley, MD

kposleyPurpose of Study: To improve the "inquiry gap" between patients and physicians by utilizing audio recordings of patient visits.

To seek evidence to apply to patient care, a physician must first identify gaps in their clinical knowledge base.  However, based on the biomedical literature and our observations, many clinical questions go unrecognized, unasked, and unanswered.  We call the failure to recognize and act upon clinical uncertainty the “inquiry gap”.  The inquiry gap undoubtedly results in lost opportunities for learning and possibly results in missed opportunities for improving patient care.

The project will entail audio recording a single post-call attending round of seven PAVA hospitalists.  The hospitalist group represents a cross-section of ages and levels of clinical experience.  Hospitalists and trainees will be blinded to the study’s focus on inquiry.  Post-call rounds will be recorded to afford some degree of homogeneity between team encounters.  We assume each attending and team will produce two hours of audio in the course of patient rounds.  All recordings will be analyzed by the research team to identify moments of actual and potential inquiry, which will help develop the language of clinical uncertainty.  Each attending will review their audio recording and receive personalized feedback from an EBP clinician and librarian in a post-review session.  From this review, we hope the participant will become more aware of and better able to understand the role of inquiry in their practice, and through feedback, begin to identify opportunities for fostering inquiry and self-assessment skills.

Veronica Yank, MD

vyankPurpose of Study: Develop and test advertising materials that help promote effective, inexpensive renal agents for patients with moderate renal insufficiency.

Chronic renal insufficiency is an undertreated condition that if left unaddressed can lead to dialysis dependence or the need for kidney transplantation.  It is also an under-recognized independent risk factor for cardiovascular disease.  If activated to act on their own behalf, patients may ask their physicians to prescribe inexpensive renal-protective agents (e.g., ACE-inhibitors) that can slow or prevent such progression.  Targeted direct-to-patient advertisements may prompt patients to ask their physicians to prescribe these medications.

The objectives of this study are to 1) Characterize the target patient population of adult patients with moderate renal insufficiency in Stanford primary care (Internal Medicine or Family Medicine).  2) Characterize the sub-sets of patients not yet on an ACE-inhibitor (or ARB) as documented in EHR.  3) Develop advertising-style materials that would promote effective, cheap renal protective agents (e.g., generic ACE-inhibitors) for patients with moderate renal insufficiency.  4) Test these advertising materials —paired with material meant to jump-start a shared decision-making conversation between patient and physician—for acceptability and impact via survey and focus groups with both patients and physicians


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