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Assessment and evaluation guidelines inform programmatic changes necessary for educational effectiveness. Presently, no widely accepted guidelines exist for educators to assess learners and evaluate programs regarding social determinants of health (SDOH) during physician and physician assistant (PA) education. We sought to garner expert consensus about effective SDOH learner assessment and program evaluation, so as to make recommendations for best practices related to SDOH education. We used a Delphi approach to conduct our study (September 2019 to December 2020). To administer our Delphi survey, we followed a three-step process: 1) literature review, 2) focus groups and semi-structured interviews, 3) question development and refinement. The final survey contained 72 items that addressed SDOH content areas, assessment methods, assessors, assessment integration, and program evaluation. Survey participants included 14 SDOH experts at US medical schools and PA programs. The survey was circulated for three rounds seeking consensus, and when respondents reached consensus on a particular question, that question was removed from subsequent rounds. The geographically diverse sample of experts reached consensus on many aspects of SDOH assessment and evaluation. The experts selected three important areas to assess learners' knowledge, skills, and attitudes about SDOH. They identified assessment methods that were "essential", "useful, but not essential", and "not necessary." The essential assessment methods are performance rating scales for knowledge and attitudes and skill-based assessments. They favored faculty and patients as assessors, as well as learner self-assessment, over assessments conducted by other health professionals. Questions about separation versus incorporation of SDOH assessment with other educational assessment did not yield consensus opinion. The experts reached consensus on priority outcome measures to evaluate a school's SDOH program which included student attitudes toward SDOH, Competence-Based Assessment Scales, and the percentage of graduates involved in health equity initiatives. Based on the Delphi survey results, we make five recommendations that medical and PA educators can apply now when designing learner assessments and evaluating SDOH programming. These recommendations include what should be assessed, using what methods, who should do the assessments, and how they should be incorporated into the curriculum. This expert consensus should guide future development of an assessment and evaluation toolkit to optimize SDOH education and clinical practice. Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2022.2045490. [ABSTRACT FROM AUTHOR]

Background: Obtaining an adequate volume of sweat to measure chloride is a challenge for many cystic fibrosis centers. The standard for patients older than 3 months is a less than 5% quantity not sufficient (QNS) rate; the suggested goal for patients aged 3 months or younger is a less than 10% QNS rate. St. Alexius Medical Center (SAMC) began performing sweat chloride testing in 2008. After an initial period of testing, a quality improvement (QI) program for sweat testing was instituted to improve QNS rates. Methods: Quantity not sufficient rates were evaluated before and after implementation for patients aged 3 months or younger and those older than 3 months. The QNS rates for each technician performing the tests were also evaluated. Results: Improvement was observed in QNS rates after implementation of the QI initiative regardless of patient age. After QI was implemented, QNS rates improved for most technicians. Conclusion: This study demonstrates how a QI improvement initiative can significantly improve QNS rates in sweat testing of infants, especially under 3 months of age. [ABSTRACT FROM AUTHOR]

Three graduate health science programs at a liberal arts university collaborated with a Hispanic senior community center to develop a program to address the needs of the transforming healthcare delivery system with an integrative medicine and health (IMH) and interprofessional practice (IPP) focus. The partnership resulted in a case-based IPP student experience with the goal of developing a student-authored case study to improve the health of center clients using the social determinants of health. The evaluation of student outcomes was based on qualitative analysis of written case studies and validated quantitative assessment tools, whereas client outcomes were measured by qualitative feedback. Final case studies demonstrated a range of case-study completion, with most teams including the majority of unique case-study elements. Senior community clients reported comfort with the program and recommended the program to others. After implementation, the academic-community partnership model was shown to be successful in implementing a strategy to prepare students for the IPP workforce in the absence of best practice recommendations. [ABSTRACT FROM AUTHOR]

Abstract: Approximately 10–80% of patients with Cystic Fibrosis (CF) have vitamin D deficiency. Obtaining therapeutic vitamin D levels has been a challenge for CF care providers using current recommended high-dose oral ergocalciferol (400,000 IU over 2 months). The objective of this study was to evaluate the safety and efficacy of a 2-week, very high dose ergocalciferol (700,000 IU over 14 days) repletion strategy in children and young adults with CF. As part of a quality improvement initiative, a prospective cohort study was performed from January through May 2007. Phase I included identifying individuals with CF who were subtherapeutic in 25-OH D. In phase II, 50,000 IU of ergocalciferol was prescribed for a 14 day term and administered daily. During phase III, a post treatment 25-OH D level was obtained to determine improvement. Baseline demographics and clinical characteristics were obtained at study entry. Stratification of the post 25-OHD levels was defined. Eighteen individuals with CF participated in the study. The mean age was 17±5 years (range 6–25 years). One hundred percent were pancreatic insufficient and required pancreatic enzyme replacement. All 18 had 25-OHD levels less than 30 ng/mL pre-treatment. Seventeen of the 18 (94%) participants became therapeutic in the 2-week interval. No patients had values considered high abnormal (100–150 ng/mL) or toxic (>150 ng/mL). Mean change was noted at an increase of 37.3±22 ng/mL in the 2-week period (p <0.001). Pre and peripubertal individuals had a significantly greater increase in 25-OH D levels. The results of this study demonstrate that very high dosing of vitamin D using oral ergocalciferol over a 14 day period is an effective strategy in achieving therapeutic levels of 25-OH vitamin D in children and young adults with CF. We believe this regimen deserves further study. [Copyright &y& Elsevier]