UT Southwestern Electronic Theses and Dissertations
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Browsing UT Southwestern Electronic Theses and Dissertations by Author "Abraham, Reeni"
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Item Development of Video and Simulation-Based Communication Skills Learning: Responding to Emotions(2021-05-01T05:00:00.000Z) Nguyen, Trung Tan; Siropaides, Caitlin; Sendelbach, Dorothy; Abraham, ReeniPROBLEM: Responding appropriately to patients’ emotions and concerns is vital for excellent patient care and outcomes. There is a lack of training in this area, with the need to educate healthcare providers about how to appropriately respond to emotions. While communication skills training programs exist for undergraduate medical education, medical students often feel unprepared in responding to patients’ emotions INTERVENTION: A 90-minute small group exercise was developed for second-year pre-clinical students at a large United States medical school in Texas. The exercise consisted of faculty-facilitated small group discussion of two video examples of a patient encounter, comparing clinician responses to patient emotions. The exercise utilized a framework for identifying skills and patient impact of verbal expressions of empathy to different patient emotions. CONTEXT: This curriculum sought to demonstrate examples of strong patient emotions for preclerkship students, and introduce a framework of concrete communication skills that can positively impact a clinical encounter. Data was collected by questionnaires delivered immediately pre-session and post-session, as well as 3 months post-session. Survey questions assessed student perception of effectiveness of the exercise, student-reported preparedness and feeling equipped to perform various communication skills during clinical visits. Paired t-tests were performed and data analyzed for qualitative responses. OUTCOMES: The process evaluation yielded a positive subjective learner response to the exercise which was sustained at 3-month follow-up. The students (N=161 paired for the immediate pre- and post-survey) reported significant increases in knowledge and preparedness to recognize and appropriately respond to different patients’ emotions (P= 0.001). Qualitative data were also captured in the surveys. LESSONS LEARNED: This video-based small group discussion of skills to express verbal empathy is perceived by pre-clinical medical students to be beneficial, and to improve their knowledge and preparedness for using empathic skills in the future. There is a need for further investigation whether this type of communication skills training results in behavior change and is sustained long-term.Item Formative Feedback Passport: A Tool to Engage Students in Reflecting on and Incorporating Mid-Point Feedback(2022-05) Postma, Heather Elizabeth; Abraham, Reeni; Collins, Sarah; Brinker, StephanieBACKGROUND: The importance of formative feedback in undergraduate medical education is widely appreciated; however, it is historically inadequate. The formative feedback passport (FF tool) was developed and implemented in the Internal Medicine (IM) clerkship at UT Southwestern to address these concerns. OBJECTIVE: This dissertation examines the FF tool's role in facilitating an optimal formative feedback process. METHODS: Initially, a pre-intervention study was conducted, in which randomly selected, de-identified FF tools from the 2018-2019 IM clerkship were analyzed for content and quality of student reflection. Results revealed that student reflection on feedback was insufficient, with transformative, thoughtful reflection seldom occurring. In response to these findings, the FF tool's instructions were augmented with a module to encourage critical reflection. Subsequently, a post-intervention study was conducted, in which randomly selected, de-identified FF tools from the 2020-2021 IM clerkship were analyzed in the same manner as the pre-intervention study. RESULTS: 149 feedback tips from 50 FF tools were included in the pre-intervention study, and 162 feedback tips from 54 FF tools were included in the post-intervention study for a total of 311 feedback tips from 104 FF tools analyzed. In both studies, most of the feedback tips aligned with established standards for resident and faculty evaluators. In addition, the mean scores for each REFLECT Rubric criterion were significantly higher in the post-intervention group than the pre-intervention group. CONCLUSION: The FF tool is an invaluable electronic feedback tool in the IM clerkship at UT Southwestern. It enables documentation of formative feedback and promotes critical student engagement, reflection upon feedback, and the development of plans to implement feedback for improvement. Study results demonstrate that students receive formative feedback from an attending, resident, or patient that is appropriate in content. Additionally, study results demonstrate that the intervention improved student engagement and quality of reflection on feedback using the FF tool.Item A Simplified Risk Score for Predicting the Incidence of Major Complications after Complex Abdominal-Pelvic Resections(2016-04-01) Bennett, Adam Jacob; Mansour, John; Brancaccio, Anne; Abraham, ReeniBACKGROUND: The POSSUM system is used to predict risk of complications following general surgical procedures. This 18-factor instrument has been challenging to apply to most surgical oncology patient populations. Our aim is to develop a simplified scoring system that is highly correlated with the incidence of major complications. OBJECTIVE: To develop a simplified scoring system that is highly correlated with the incidence of major complications. METHODS: We queried a single-institution IRB-approved prospective database from a surgical oncology population from January 2008 to December 2012. We identified patients undergoing complex abdominal or pelvic resections and factors associated with the development of major (Clavien-Dindo ≥ III) complications. Factors not included in the POSSUM system were incorporated into a new scoring system based on univariate correlation with complication rates (Chi-square). Optimal binning generated an ideal cut-off value associated with major complications. A composite scoring system (SOPI) was compared to standard POSSUM predictions using ROC analysis. RESULTS: We identified 831 patients undergoing pancreatic (23%), hepatic (23%), colorectal (22%), esophagogastric (16%), retroperitoneal (4%), combined (3%), or other type (10%) of resection. Major complications occurred in 17% of patients. Two original POSSUM factors were included in the new SOPI model (cardiac history and EBL). Four factors improved correlation with complication rate: gender (female/male-1/3 points); operation type (retroperitoneal/ pancreatic or rectal/others-4/2/1 points); curative intent (curative/non-curative-1/2 points); and cancer (no cancer/cancer-1/2 points). ROC analysis generated a greater AUC for the simplified 6-factor system than standard 18-factor POSSUM (AUC: 0.676 vs 0.631). Increasing SOPI quartiles higher risk of major complications (5%, 15%, 20%, 29%; p-value < 0.001). CONCLUSION: The efficacy of POSSUM or P-POSSUM for complex abdominal and pelvic resections remains unclear. The SOPI system, which is comprised of only 6 factors, was equivalent to P-POSSUM for predicting major complication rates (Clavien-Dindo score of at least III) for surgical oncology patients. Validation in a large, independent dataset is necessary before the system can be widely applied.