Medical Education Commons^™

A Performance And Quality Improvement Intervention Integrating Molecular Testing To Support Personalized Cancer Care In Lung And Thyroid Cancers, Suzanne Murray, Monica Augustyniak, John Vu, Elbert Y. Kuo, Manolo G. Pasia Jr., Sheri L. Rivera, Kelly M. Rodriguez, Vivek Subbiah, Patrice Lazure, Ecaterina E. Dumbrava

Advances in Cancer Education and Quality Improvement

Introduction: Molecular testing has been underutilized in the diagnosis and treatment of cancer patients, despite its potential to significantly impact clinical decision-making and resulting health outcomes.

Objectives: This project aimed to evaluate the process and impact of a performance/quality improvement (PI/QI) intervention to optimize the integration of molecular testing for patients with non-small cell lung cancer (NSCLC) or thyroid cancer (TC).

Methods: Physicians, advanced practice providers, and nurses were engaged in the PI/QI at 2 cancer centers (Site A and Site B) for up to 18 months following a pre-intervention needs assessment. Gaps identified at baseline informed …

A Cancer Haiku Triptych, Larry C. Driver

Advances in Cancer Education and Quality Improvement

This trio of patient-inspired Haiku attempts to capture the joyful optimism of cancer-free life in the first pair of spring and summer, with a hint of transition in the second, and the final autumn into winter piece heralding the realization that smoldering cancer has flared-up with the possibility of the end of life.

Impact Of Clinical Decision Support Tool Implementation On Injectable Calcitonin Usage, Petar Jordanov, Ashley Crouch, William Towers

Advances in Cancer Education and Quality Improvement

Calcitonin injection is a high-cost medication used to treat hypercalcemia in hospitalized patients. Many institutions have implemented strategies to reduce unnecessary use or waste of calcitonin, including dose rounding, formulary restriction criteria, and limiting the number of doses a patient may receive. MD Anderson Cancer Center (MDACC) utilizes approximately 1200 calcitonin doses per year with no current formulary or dosing restriction criteria. The goal of this study was to evaluate patterns of use of calcitonin at MDACC and implement and evaluate the impact of clinical decision support tools to reduce unnecessary calcitonin use and waste. This is a single-center quality …

Streamlining Nuclear Theranostic Clinic Workflow, Charisma Desai, Anne Fisher

Advances in Cancer Education and Quality Improvement

Nuclear medicine clinic needs have drastically changed with the emergence of theranostics, exciting new agents in the fight against cancer. However, administering these agents is a resource-intensive task, increasing demand for physician consultation time with patients, clinic office space, and scanner time. We examined our institution’s nuclear medicine clinic workflow and interviewed the clinic’s front desk staff, technologists, nurses, managers, physicians, and patients to find sources of delays, dissatisfaction, and decreased efficiency. An Ishikawa diagram and decision matrix helped us determine the most impactful intervention with our available resources. For this cycle, we focused on the consent process. Theranostic patients …

Interactive Clinical Dashboard For Psychiatric Oncology Services At A Cancer Institution: A Quality Initiative, Maria Shabih, Adelita D. Martinez, Alan D. Valentine, Deepti A. Chopra

Advances in Cancer Education and Quality Improvement

Accurate documentation of reasons for psychiatry consultations is critical for developing an effective treatment plan for the patient and improving quality of care through targeted interventions. The purpose of this project was to create an interactive dashboard on Power BI. We downloaded the report from Epic on SAP BI. On an Excel sheet, we recoded the reason for consults and categorized using a keyword list and recoded the consults into distinct, categories such as "anxiety," "depression," and "altered mental status (AMS)," with data spanning 2 fiscal years.

Key findings from the dashboard revealed that anxiety and depression accounted for most …

Designing An Electronic Patient-Reported Outcomes Information Infrastructure Supported By The Re-Aim Implementation Framework, Amy C. Moreno, Angela Peek, Toshiko S. Stein, Kevin R. Shook, Sara M. Ali, Laia Humbert-Vidan, Aileen Chen, Miriam Lango, Anna Lee, Michael Spiotto, William H. Morrison, Adam S. Garden, Jack Phan, Steven J. Frank, Katherine Hutcheson, David I. Rosenthal, Clifton D. Fuller, G Brandon Gunn

Advances in Cancer Education and Quality Improvement

Objective: Patient-reported outcomes (PROs) contain valuable information that can be leveraged by providers to perform timely interventions and improve quality of life and survival. However, the implementation of electronic PROs (ePROs) remains a challenge from technical and evaluation perspectives. Our objective was to construct a robust electronic health record (EHR)-integrated ePRO information infrastructure founded on RE-AIM (reach-effectiveness-adoption-implementation-maintenance) principles.

Materials and Methods: We used Epic Systems as our EHR platform to build the MD Anderson Symptom Index Head and Neck Module (MDASI-HN) for release to all patients undergoing evaluation and/or treatment in our HN Radiation Oncology clinics. RE-AIM metrics were …

Clinical Instructors In Gynecologic Oncology: Addressing Gaps In Cancer-Related Care And Gynecology Training Deficiencies, Sadhvi Batra, Ann Marie Mercier, Robert Wenham

Advances in Cancer Education and Quality Improvement

The shift toward minimally invasive techniques and sub-specialization in gynecology has reduced generalist surgical experience, prompting new training roles to better manage complex benign conditions and cancer survivorship.

The Use Of Firgun To Improve Burnout And Workplace Civility In A Pediatric Cancer Center, Karen Moody, Jerry Stein, Deena Levine, Arshia Madni, Clark R. Andersen, Amy Heaton, Alakh P. Rajan, Demetrios Petropoulos, Jian Wang, Deborah Kramer

Advances in Cancer Education and Quality Improvement

Burnout afflicts 35% to 44% of pediatric oncology physicians, nurses, and interprofessional staff and is related to excessive workloads and emotional exhaustion. Conversely, a healthy work environment is a protective factor for burnout among physicians and nurses. Meaningful recognition is a published standard necessary for creating a healthy work environment. This study aimed to reduce staff burnout through firgun, defined as a heartfelt way to express accomplishments of another person. Pediatric oncology staff completed a firgun educational module and logged acts of firgun during a 3-month study period. Validated measures assessing burnout, workplace civility, well-being, work-life balance, and perceived …

From Imaging To Impact: A Multi-Disciplinary T32 Program Framework And Initial Insights For Training In Image-Guided Cancer Therapy, Kari J. Brewer Savannah, Stephen Y. Lai, Clifton D. Fuller, Kristy K. Brock

Advances in Cancer Education and Quality Improvement

As multi-disciplinary image-guided assessment and therapies become increasingly important for precision oncology, the need for comprehensive training opportunities that effectively prepare the next generation of clinician-scientists and scientists is evident. We present an innovative, evidence-based research training framework that integrates the following critical features: 1) intentional and personalized mentoring and career development, 2) immersive research in image-guided cancer therapy, 3) strategic mentored clinical exposure, 4) structured didactic learning and professional development opportunities, and 5) mentored grant writing. Designed to foster scientific rigor, translational thinking, and multi-disciplinary collaboration, the Image-Guided Cancer Therapy T32 Training Program (IGCT-T32) aims to prepare postdoctoral fellows …

5x-Multiplier Vs 3-Tier Model For Discharge Opioid Prescriptions After Intra-Abdominal Cancer Surgery: Randomized Clinical Trial Protocol, Brittany C. Fields, Timothy E. Newhook, Heather A. Lillemoe, Wei Qiao, Jose A. Karam, Surena F. Matin, Larissa A. Meyer, Ching-Wei D. Tzeng

Advances in Cancer Education and Quality Improvement

Background

Surgeons provide up to 10% of total opioid prescriptions across all specialties, and more than one-third of surgeon-prescribed medications are opioids. Patient-reported opioid consumption and risk of persistent opioid use beyond the postoperative recovery period correlate with the initial opioid quantity prescribed at discharge. Interventions to reduce postoperative opioid prescribing have demonstrated no adverse effects on pain control or increased need for prescription refill; however, in the absence of standardized prescription protocols, opioid prescribing practices vary widely.

Objective

The study objective is to identify the opioid prescribing model that provides the lowest oral morphine equivalents (OME) volume prescribed at …

Reducing The Percentage Of Intubation Time On Continuous Infusion Midazolam, Arsemen Brown, Emily Highsmith, Michelle Horng

Advances in Cancer Education and Quality Improvement

This quality improvement study was conducted at a comprehensive cancer care center with the aim to decrease the percentage of on continuous infusion (CI) midazolam by 30% by May 5, 2023. The pre-intervention and post-intervention data collection phases occurred from January 1, 2022, to October 31, 2022, and March 7, 2023, to May 5, 2023, respectively. Sedation was assessed utilizing the Richmond Agitation and Sedation Scale (RASS), and delirium was assessed utilizing the Intensive Care Delirium Screening Checklist (ICDSC). A sedation pathway and associated educational materials were developed by a multidisciplinary team and frontline staff. Interventions in the sedation pathway …

Impact Of A Goal Of Care Communication Training Program For Oncology Clinical Staff, Gary Martinez

Advances in Cancer Education and Quality Improvement

Abstract

Goals of care (GoC) refers to medical care decisions made by patients and families that are consistent with their personal values and preference choices. However, the oncology health care system does not always align with the patient’s GoC values and preferences. Clinical experts suggest formalized GoC education to improve this practice gap. Accordingly, MD Anderson Cancer Center implemented GoC training for front-line clinical staff using the evidence-based COMFORT Model to enhance the participants’ ability to have connected GoC conversations and enhance their comfort levels in responding to patients’ emotions. Our institution’s GoC education team compared the pretest and posttest …

Persistent Improvement In Opioid Perceptions And Prescribing For Cancer Surgery: 5-Year Follow-Up, Brittany C. Fields, Timothy E. Newhook, Heather A. Lillemoe, Jessica E. Maxwell, Jose M. Soliz, Keyuri U. Popat, Christina L. Roland, Jean-Nicolas Vauthey, Matthew H. G. Katz, Ching-Wei D. Tzeng

Advances in Cancer Education and Quality Improvement

Background and Objectives

We previously reported that implementation of a department-wide opioid education program led to post-education improvements in opioid perceptions and prescription recommendations, with one-month and one-year retention. With ongoing programmatic and quality improvement efforts, we sought to re-evaluate the retention of these improvements five years after initial efforts.

Methods

Attending surgeons, clinical fellows, and advanced practice providers were surveyed five years after implementation of a comprehensive, departmental opioid reduction framework in August 2018. This framework initially consisted of dedicated opioid education sessions and retrospective assessment of prescribing practices, and subsequently expanded over time to include prospective quality improvement …

Sensitive Practice For Supporting Survivors Of Sexual Violence In Oncology, Kevin R. Clark

Advances in Cancer Education and Quality Improvement

Sexual violence is a pervasive problem that has profound implications for survivors' physical and mental health. In oncology care, routine medical procedures can inadvertently trigger distress and retraumatization in survivors. This brief report outlines the principles of sensitive practice and their application in oncology care to support survivors of sexual violence. By showing respect, taking time, building rapport, sharing information, sharing control, respecting boundaries, promoting mutual learning, understanding nonlinear healing, and demonstrating an understanding of sexual violence, health care providers can create a safe and supportive environment. Implementing these principles reduces the risk of retraumatization and improves patient outcomes. Health …

Making Training Stick: Transferring Learning Back To The Job, Amanda Woods Herron, Phoebe Hessen, Katelyn J. Cavanaugh, Wykesha C. Hayes, Victor Hassid, Courtney L. Holladay

Advances in Cancer Education and Quality Improvement

Communication remains a central priority in healthcare, making it a key component of many training efforts. The positive impacts of communication training in healthcare settings have been well-established; however, the linkage of communication training to key organizational outcomes (e.g., engagement, performance, retention) remains underexplored. The present study investigated a training program targeting interpersonal communication within a large academic oncology center. We drew from Cognitive Load Theory and Social Cognitive Theory to evaluate the impact of the training on participant learning (retention and utilization), transfer (communication, decision-making, performance), and results-level outcomes (engagement and turnover). The program centered around a personality framework …

Announcing The Inaugural Issue Of Advances In Cancer Education And Quality Improvement (Ace-Qi): A Foreword By Dr. Peter Pisters, Peter Pisters

Advances in Cancer Education and Quality Improvement

No abstract provided.

The Power In Patient Education: A Collaborative Approach To Cancer Care, Eric Singhi, Aurora Lucas

Advances in Cancer Education and Quality Improvement

A viewpoint on patient education

The Impact Of Fellowship Training On Peer-Reviewed Publication Productivity In Academic Anesthesiologists As Evaluated By The H-Index, Acsa M. Zavala, Jagtar Singh Heir, Juan P. Cata, Lei Feng, Jose M. Soliz

Advances in Cancer Education and Quality Improvement

Background: The effect of anesthesiology fellowships on scholarly contributions has been minimally studied. In this study we analyzed differences in h-index between fellowship-trained and non–fellowship-trained anesthesiologists, as well as by type of fellowship, academic rank, and years in practice.

Methods: All anesthesiologists on staff between September 1, 2021, and August 31, 2022, were included in this study. The variables collected were fellowship training status, h-index, total number of publications, years in practice, academic rank, and years at the institution. For analysis, the anesthesiologists were divided into 2 groups: those with fellowship training and those without.

Results: Among 78 anesthesiologists, 40 …

Professional Alliance For Learning And Support (Pals): A Pilot Career Development Educational Program For Administrative Support Personnel In Healthcare Research, Ebonie R. Hatfield, Humberto Shaw, David P. Farris, Ronald Abraham, Dzifa Duose, Chad M. Middleton, Veronica Garza, Celia Garcia-Prieto, Ignacio I. Wistuba, Rama Soundararajan

Advances in Cancer Education and Quality Improvement

The COVID-19 pandemic has profoundly transformed the healthcare research landscape, staging unprecedented challenges for administrative research-support personnel. While career programs and retention benefits have emerged to support frontline healthcare workers facing health concerns, burnout and employee-turnover, many “classified”/administrative support staff in research departments who experience similar challenges remain without adequate structured support. This lack of structure has impacted job satisfaction, career-progression and talent retention within this crucial sector.

Recognizing the critical importance of addressing this training gap for the benefit of the broader research enterprise, the Interdisciplinary Translational Education and Research Training (ITERT) Core at UT MD Anderson Cancer Center …

Post-Discharge Telephone Intervention With A Clinical Pharmacy Specialist For Gastrointestinal Medical Oncology Patients, Jane E. Rogers, Michael Leung, Amanda Sirisaengtaksin, Jennifer Zadlo, Van Nguyen, Morgan Mace, Wendy Covert, Makenna Smack, Stacy Diao, Zhou Fang, Andrea Landgraf, Mariela Blum Murphy

Advances in Cancer Education and Quality Improvement

Background: Oncology patients are a vulnerable population with medication-related problems spanning across care settings. Gastrointestinal medical oncology (GIMO) patients often have unique medication challenges due to extensive treatment history. High-quality medication reconciliation aids in preventing medication discrepancies and potential adverse events during transitions of care. We conducted a pilot post-hospital discharge intervention with clinical pharmacy specialists for GIMO patients.

Objective: The primary objective was to identify the frequency of medication discrepancies.

Methods: GIMO patients discharged from our hospital were identified and called within 7 days of discharge. Clinical pharmacy specialist telephone encounters occurred between December 2021 and February 2022.

Results: …

Factors Associated With Emergency Difficult Tracheal Intubation And Difficult Airway Management In A Non–Operating Room Setting At A Cancer Treatment Center, Jackson Su, Neil Bailard, Jens Tan, Jeffrey Lim, Catherine Vu, Wenli Dong, Gang Zheng

Advances in Cancer Education and Quality Improvement

Difficult tracheal intubations are reported more often in the emergency non−operating room setting than in the operating setting. To identify the factors associated with emergency difficult intubation (DI) and difficult airway (DA) management in hospitalized patients with cancer, we conducted a single-center retrospective study in hospitalized patients who underwent emergency intubations in a non−operating setting from 2016 to 2019 at a cancer treatment center. Cases of DI (inability to visualize the vocal cords and/or >2 intubation attempts) and DA (DI, advanced airway device use, and/or need for a surgical airway) were included. We reviewed 763 cases; the DI and DA …

Evaluating The Impact Of A Renal Dosing Refreshable Sidebar Report On Appropriateness Of Antimicrobial Dosing At A Large Acute Care Cancer Hospital, Emily Fox, Jovan Borjan, Nancy Vuong, Hannah Aune, Claire Marten, Joshua Hendrickson

Advances in Cancer Education and Quality Improvement

Background: Appropriate antimicrobial dosing is vital in the treatment of patients with infectious diseases, though adherence to guideline recommended doses is often suboptimal.

Outcomes: This study was conducted to evaluate the impact of a renal dosing refreshable sidebar report, which displayed recommendations from a previously developed institutional antimicrobial dosing guide at the time of antimicrobial order entry. The primary outcome was adherence to daptomycin dosing guideline recommendations before and after implementation.

Methods: This was a pre- and post-quasi-experimental study at a 600-bed acute care cancer hospital. Adult patients (≥18 years old) that received daptomycin from February-April 2021 (pre-intervention phase) and …

A Tobacco Treatment Training Program Expands The Number Of Healthcare Providers Trained To Use Evidence-Based Practices And Methods, Alex Hurst, Maher Karam-Hage, Jennifer Cofer, Mehwish Javaid, Diane Beneventi, Janice Blalock, Tiffany Winter, Paul M. Cinciripini, Ernest Hawk

Advances in Cancer Education and Quality Improvement

Tobacco-use disorder remains a global health challenge, despite declining rates, and is a leading cause of morbidity and mortality, especially among special populations that disproportionally do not have access to comprehensive treatment services. The lack of trained providers and slow dissemination of new tobacco treatment knowledge are obstacles to accessing comprehensive evidence-based treatments. Less is known about the impact of specialized training programs on healthcare professionals' ability to effectively treat tobacco use. This paper reports on the evaluation of the tobacco treatment training program, training methodology, and the demographics of the specialists trained.

MD Anderson’s Tobacco Treatment Training Program (TTTP) …

In-Person And Virtual Adaptation Of An Interprofessional Palliative Care Communications Skills Training Course For Pediatric Oncology Clinicians, Karen Moody, Clark R. Andersen, Robert M. Arnold, Julie Bradley, Allie Carter, Lauren Draper, Timothy Garrington, Jonathan B. Gill, Douglas J. Harrison, Masanori Hayashi, Amy Heaton, Cynthia Holladay, Alex Lion, Alakh Rajan, Beatriz N. Rozo, Daniel V. Runco, Shermini Saini, Laura K. Salvador, Kathryn Sutton, Verna Ferguson

Advances in Cancer Education and Quality Improvement

Introduction

Empathic communication is crucial for clinicians when discussing palliative and end-of-life (PC/EOL) care with parents of children with cancer. Unfortunately, many parents report inadequate communication at these distressing times. This study evaluates the communication skills training (CST) clinicians received to deliver a PC/EOL communication intervention as part of a multi-site randomized-controlled trial (RCT). Training was provided using an in-person format and then adapted to a virtual platform to accommodate remote learners.

Methods

Clinicians were trained in dyads (one physician and one nurse [RN] or advanced practice provider [APP]) over 3 days (in-person or virtually). Four pediatric oncology cases were …

Improving Handoffs Between Outpatient Clinics And Acute Cancer Care Centers At A Tertiary Oncology Hospital Using A Quality Improvement Methodology, Mini George, Mohamed Ait Aiss, Gabriele Urschel, Maria Franco Vega, Susan Gaeta, Diane Bodurka

Advances in Cancer Education and Quality Improvement

Accrediting agencies recommend safe and accurate transfer of clinical information during care transitions. At our institution, a tertiary care cancer hospital, ambulatory clinic providers use multiple methods for communicating essential information to emergency care providers. Therefore, we initiated a quality improvement project using a standardized electronic handoff during the transfer of care between providers at outpatient clinics and acute cancer care centers. The project was launched in May 2023 and aimed to achieve electronic handoff for 70% or more of ambulatory care patients transferred to emergency care by October 2023. A multidisciplinary team developed an electronic handoff, provided training, and …

Writing And Publishing Scientific Articles: Course Workbook, Editing Services, Research Medical Library (Formerly Scientific Publications)

Writing and Publishing Scientific Articles: Course Workbook

No abstract provided.

The Write Stuff - Winter 2023 (Vol. 20, No. 1), Research Medical Library

Write Stuff 2023

• Protected health information
• Literature reviews: Which type should I write?
• Finding examples of funded NIH applications
• New NIH policy for data management and sharing now in effect
• Unusual terms used in scientific writing and publishing: Person-first language

The Write Stuff - Summer 2022 (Vol. 19, No. 3), Research Medical Library

Write Stuff 2022

• Next steps after grant rejection
• Resources on new NIH policy for data management and sharing
• What should you include as supplemental material?
• Tips for collaborating with manuscript authors online
• Unusual terms used in scientific writing and publishing: Overlay journal

The Write Stuff - Spring 2022 (Vol. 19, No. 2), Research Medical Library

Write Stuff 2022

• New PRISMA guidelines for systematic reviews
• Top tips for writing article titles
• Key points from NIH seminar: “Including diverse populations in NIH-funded clinical research”
• Unusual terms used in scientific writing and publishing: NISO

The Write Stuff - Winter 2022 (Vol. 19, No. 1), Research Medical Library

Write Stuff 2022

• NIH allows flexibility for applicants affected by the COVID-19 pandemic
• Whom to contact for help with your NIH grant applications
• How to write a peer review
• Council of Science Editors launches new podcast
• Unusual terms used in scientific writing and publishing: QWERTY, AZERTY, and Dvorak