e46 ABSTRACTS
an attempt to communicate information about patients and dispo-
sition. Future directions for this project will include maintaining
the survey for periodic “temperature checks” of attitudes between
nursing and residents and continuing to focus on ways to improve
relationships. We have also fostered a community of inclusive-
ness and interdisciplinary work. We are hosting a two day diver-
sity workshop and it is designed to be interdisciplinary. We will
bring together nurses, child life specialists, technicians and phy-
sicians to discuss issues of diversity in our hospital. We believe
that through seeking nursing input on front line care and creating
a community of inclusiveness we will improve nurse resident re-
lations and ultimately patient care.
112. CULTURAL AND LANGUAGE GAPS: OVERCOMING
COMMUNICATION BARRIERS ON THE PEDIATRIC
WARD
Neeru P. Narla, MD, Children’s Hospital/Boston Medical
Center, Zeena Audi, MD, Catherine Distler Michelson, MD,
Alan M. Leichtner, MD, Children’s Hospital/Boston Medical
Center, Boston, MA
BACKGROUND: Patients with limited English proficiency are
more likely to suffer adverse events. Residents consistently report
a lack of preparation in caring for an increasingly diverse US pop-
ulation. While certain cultural competence-promoting educa-
tional interventions have been met with success, limited data
exist on their effectiveness and application to pediatric trainees
and populations.
OBJECTIVES: 1. Improve the quality of care delivered on a pe-
diatric inpatient ward by creating and implementing a new cul-
tural communication curriculum for residents that leverages
interpreters as key stakeholders. 2. Evaluate impact of direct
real-time interpreter feedback on resident learning and perfor-
mance.
METHODS: After surveying the residents and interpreters,
communication barriers were identified and explored using inter-
preter focus groups. Through this, 10 tips to overcome communi-
cation barriers with multicultural patients and 10 tips to overcome
barriers with interpreters were identified (10 and 10). We then per-
formed a needs assessment of existing interventions aimed at
improving multicultural communication. Using this knowledge,
we designed and implemented the intervention below.
RESULTS: Before Curriculum Implementation: A group of in-
terpreters were trained as “Interpreters-as-Teachers” (IAT).
Training centered on their role as educators, characteristics of
effective feedback, reviewing the 10 and 10, and the new resident
curriculum. Trained interpreters were preferentially assigned to
work on the pediatric ward. A rubric was created for the IAT to
provide real-time feedback to the residents following patient en-
counters. The rubric was pretested with multiple interpreters and
residents. The Resident Curriculum: The Primer. In the first week
of the rotation, residents are instructed to have at least one multi-
cultural patient interaction evaluated by a trained interpreter, to
describe areas of strength and improvement in each resident’s
communication. The Flipped Classroom and Simulation. In the
second week, residents are asked to complete a brief interactive
online module which was developed using generative learning
and flipped classroom theory to optimize retention of the 10
and 10. They then undergo a one hour simulation session run
by physicians and interpreters, followed by time for debrief and
review of the 10 and 10. Information from the online module
will be directly applicable to the simulation. Re-Evaluation.
In the final weeks of the rotation, residents again engage in a pa-
tient encounter evaluated by an IAT, using the same rubric for
ACADEMIC PEDIATRICS
comparison of resident progress. Subjects serve as their own con-
trol with pre- and post-intervention data.
CONCLUSION: In applying a flipped classroom, direct simula-
tion approach along with interdisciplinary feedback, we hope to
have created a method by which the residents can effectively learn
how to improve communication with linguistically and ethnically
diverse populations.
113. IMPROVING RESIDENT COMMUNICATION SKILLS
WITH PATIENTS OF DIVERSE BACKGROUNDS
Ruchika Mohla, MD, MS, Paul Schwartzberg, DO, Neptune,
NJ
SETTING: Residents often do not receive formal education in
communication skills in the setting of cultural competency. The
objectives of this new strategy were:1) To assess resident under-
standing of cultural competency and comfort level with patients
of diverse backgrounds 2) To determine if simulated patients
can be useful in teaching and evaluating communication skills
and cultural competency.
INTERVENTION: Five first-year pediatric residents in our pro-
gram participated in a case-based session using local high
school theater students simulating patients with diverse cultural
and religious backgrounds. To evaluate each resident, we devel-
oped a pre-/post resident survey and a “cultural competency”
communication checklist. Additionally, each participating resi-
dent received feedback from us, other first-year residents, special-
ists from our Office of Cultural Diversity, and the theater students
following a medical interviewing protocol created by the Chil-
dren’s Hospital of Pittsburgh.
PRELIMINARY OUTCOMES: Our preliminary data suggest that
patient-based simulation exercises may be an effective tool in
teaching culturally competent communication and improving
resident comfort in interacting with individuals of diverse back-
grounds. Additionally, we were able to complete the session in
less than two hours, the exercise itself required no cost and the
medical interviewing protocol provided an effective structure
for the activity. We are currently expanding this project to include
residents from our Department of Internal Medicine and second-
year pediatric residents (data to be included for the session) as
well as creating a new longitudinal Cultural Competency Curric-
ulum including lectures, a “Cultural Competency Day,” and work-
shops from our Office of Cultural Diversity.
114. INTERPROFESSIONAL COLLABORATION: A
FORWARD-LOOKING APPROACH TO TEAM-BASED
HEALTHCARE
Carol Fries, MD, Karla Suter, MD, Karol Hyjek, MD,
Rachel Diamond, MD, University of Rochester, Rochester,
NY
BACKGROUND: Interdisciplinary collaboration is necessary to
achieve best-practice care delivery. Nurses, residents, and all
healthcare personnel (HCP) are vital to the team and must work
together to optimize patient care.
AIMS: 1. To improve interprofessional communication, 2. To
educate HCP about effective teamwork strategies, 3. To sustain
tangible, interdisciplinary, team-building efforts.
METHODS: Representatives from each discipline formed our
Interprofessional Collaboration Committee. A five-point Likert
Scale surveyed hospital-wide perceptions of interprofessional re-
lations to identify targets for intervention. Respondents, regard-
less of discipline, are 40% less likely to report feeling very
comfortable communicating with those outside their discipline