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  Understanding Patient Uncertainty as a Driver of Emergency Department Utilization: A Concept Mapping Approach

  Angela Gerolamo, PhD, RN; Shannon Doyle, MPH; Rhea E. Powell, MD, MPH; Amanda M.B. Doty, MS; Marianna LaNoue, PhD; and Kristin L. Rising, MD, MSHP

  Background and Purpose

  • Most previous research regarding factors associated with increased risk of emergency department (ED) use has been done via retrospective review of medical records rather than obtaining patients’ perspectives.
  • Recent research identified patient uncertainty related to symptoms as a primary motivator for seeking ED care, and ongoing uncertainty at the time of ED discharge as an unmet need (Rising et al. 2015; Rising, Hudgins, Reigle, Hollander, & Carr 2016).
  • While providers have limited ability to influence many factors identified by retrospective medical record review (e.g. financial concerns), patient uncertainty can be addressed by providers directly. To do so we must first define domains of uncertainty that patients experience in order to inform targeted interventions to address patient uncertainty.
  • The objective of this research was to engage patients through group concept mapping (GCM) to conceptualize the domains of uncertainty that contribute to decisions to seek care in the ED.

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  Improving Bedside Procedural Safety through Optimizing Timeout Documentation and a Pre-procedure Checklist

  Jennifer Harris, MD; R. Benson Jones, MD; Kristin Lohr, MD; Grant Turner, MD; Drew Kotler, MD; Justine Blum, MD; Megan Margiotta, MD; Matthew Bokhari, MD; Erica Li, MD; Riti Kanesa-thasan, MD; Bracken Babula, MD; and Rebecca Jaffe, MD

  Aim

  GOAL: Improve the safety of patients undergoing bedside procedures while maintaining the full spectrum of graduated autonomy in procedure training for residents.

  SMART Aim: Increase the rate of timeouts documented for bedside procedures from 29% to 50% by June 2018.

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  Recurrent SIADH after Switching Citalopram to Very Low Dose Duloxetine in the Elderly

  David Jeong, MD, CAQSM, CEP, RMSK; Patrick Doggett, MD; Kristine Swartz, MD; Lauren Hersh, MD; and Brooke Salzman, MD

  Objective

  • Duloxetine-induced SIADH has been seldom reported
  • This case study emphasizes the importance of suspecting rare adverse effects of recurrent SIADH after switching an SSRI to duloxetine in older adults

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  Utilization of Exercise Prescriptions for Older Adults

  David Jeong, MD, CAQSM, CEP, RMSK; Brooke Salzman, MD; and Jeremy Close, MD

  Objective

  This study was conducted to investigate

  1) Providers` knowledge and physician attitude about Exercise and Physical activity (PA) recommendations for Older Adults (OA)

  2) Frequency of utilizing written exercise prescriptions

  3) Barriers to using exercise prescriptions in primary care practice

  4) Providers’ interest in learning about and utilizing exercise prescriptions

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  Sonographic Findings of a Semi-Professional Football Player with 1st MTP Joint Pain: Gout or Turf Toe?

  David Jeong, MD, CAQSM, CEP, RMSK; Danielle Snyderman, MD; Lauren Hersh, MD; and Jeremy Close, MD

  Purpose

  Aim : To review the applications and indications of sonography for forefoot disorders, especially gout and plantar plate injury of 1^st MTP joint.

  Introduction

  • Forefoot disorders are common but forefoot ultrasound is underutilized.
  • Point-of-Care Ultrasound was utilized in initial workup evaluating acute on chronic 1^st MTP joint pain in our case study.

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  Association between Knowledge and Performance in Clerkships and USMLE Step 2 CK Scores: Implications for Counseling and Academic Decision-making

  Abigail Kay, MD; Kristin DeSimone, MD; Jon Veloski, MS; and Steven Herrine, MD

  Background

  Step 2 CK scores are of increasing importance in medical student career planning. In the National Resident Matching Program 2014 Program Director Survey, Step 1 scores were the highest-rated among 33 factors used in screening applicants to be interviewed (94% cited it with a mean rating of 4.1 on a 5 point Likert scale); Step 2 scores were rated fourth in importance (80% cited it, mean rating of 4.1). When citing factors for ranking a given applicant, Step 1 scores ranked 5^th (80% cited, with mean rating of 4.1) and Step 2 CK scores ranked 7^th (71% cited, with mean rating of 4.1) Previous studies have shown a relationship between Step 2 scores and subsequent board certification, and that women outperformed men in most content areas in Step 2. The purpose of this study was to examine the association between knowledge and performance in clerkships, as measured by final clerkship grade and Step 2 scores after adjusting for background factors, such as preclinical knowledge.