SIGNIFICANCE OF SECOND YEAR MEDICAL STUDENTS PARTICIPATING IN THE 48-HOUR HOSPICE HOME IMMERSION PROJECT, 2017–2018

Abstract Medical education on palliative medicine and end-of-life care is generally lacking in the medical curricula. The University of New England College of Osteopathic Medicine (UNECOM) Learning by Living: 48 Hour Hospice Home Immersion Project is an immersion-based learning model whereby UNECOM 2nd year students live in an18-bed acute care hospice house to care for dying patients, provide family support, and conduct post-mortem care. This project determined if and in what ways immersion experiences were valuable in augmenting student medical end-of-life care education during AY 2017-2018.Retrospective ethnographic/autobiographic data were analyzed from the eight randomly selected student hospice immersion journals (approx. 200 pages) who participated during academic year 2017-18. Pre-fieldwork, fieldwork, post-fieldwork journals were reviewed and analyzed using manual content analysis followed by NVivo 12+ analysis. Thematic coding resulted in representative quotes, key words, and native concepts. Inter-rater reliability was established with the use of a codebook and agreed upon thematic definitions. Four key themes included: Subversion of End of life (EOL) Expectations; Character Development/Introspection; Exposure to Diverse Cultural/Spiritual Perspectives; and Skills to Bring into Future Practice. Proximity to death/dying resulted in reflections on values and priorities, and a renewed sense for compassionate patient care. Students developed skills for future practice, including competency in EOL and post-mortem care, navigating difficult, emotionally laden family dynamics, and contributing to an interprofessional staff team even in uncomfortable situations. This immersion positively affected student perspectives about death and end-of-life care; creating life-altering experiences in patient-centered-care. Students stated significant impacts to employ as a physician.

Care planning may be reserved for a follow-up consultation after the patient and family have had time to understand and accept the diagnosis.While we used a dementia expert nurse to perform the BHC, given the types of concerns identified, a supervised, trained, unlicensed health professional (e.g., a care team navigator) may be appropriate to perform the BHC.

A VIRTUAL STAFF TRAINING TO IMPROVE COMMUNICATION FOR OLDER ADULTS DURING MASK WEARING
Sara Mamo, Katherine Garrity, and Kara Wheeler, University of Massachusetts Amherst, Amherst, Massachusetts, United States The need for masking protocols in care centers for older adults exacerbated communication challenges in an already difficult environment.The purpose of this study was to alleviate the burden of communicating while wearing masks by providing a virtual staff training that introduced a headset amplifier and communication tips.The training was delivered via Zoom to small groups of staff at three Programs for All-inclusive Care for the Elderly (PACE®) organizations.The training included education about the impact of age-related hearing loss, instructions for using a headset amplifier, and communication tips.Staff were encouraged to use the amplifier with as many participants as possible to ease communication while wearing masks-rather than targeting participants based on hearing status.A pre/post quasi-experimental approach was undertaken.Fifty-one staff members completed the training and immediate pre/post questionnaires to measure knowledge gain.Follow-up questionnaires (including open-ended responses) were collected at 2-(n = 29), 4-(n = 23), and 6-months (n = 23) post-training.In addition, we completed one focus group (n = 5) and one in-depth interview regarding the feasibility of participation in the research project and brainstorming to increase use of the amplifiers.By integrating quantitative and qualitative findings, we highlight communication improvements when using the amplifiers and tips for integrating amplifiers into group care programs.The findings from this study will contribute to the development of a large-scale intervention to address hearing loss and support communication for older adults in group care settings.

SIGNIFICANCE OF SECOND YEAR MEDICAL STUDENTS PARTICIPATING IN THE 48-HOUR HOSPICE HOME IMMERSION PROJECT, 2017-2018 Samuel Hanlon, Benjamin Packard, and Marilyn Gugliucci, University of New England College of Osteopathic Medicine, Biddeford, Maine, United States
Medical education on palliative medicine and end-oflife care is generally lacking in the medical curricula.The University of New England College of Osteopathic Medicine (UNECOM) Learning by Living: 48 Hour Hospice Home Immersion Project is an immersion-based learning model whereby UNECOM 2nd year students live in an18-bed acute care hospice house to care for dying patients, provide family support, and conduct post-mortem care.This project determined if and in what ways immersion experiences were valuable in augmenting student medical end-of-life care education during AY 2017-2018.Retrospective ethnographic/ autobiographic data were analyzed from the eight randomly selected student hospice immersion journals (approx.200 pages) who participated during academic year 2017-18.Prefieldwork, fieldwork, post-fieldwork journals were reviewed and analyzed using manual content analysis followed by NVivo 12+ analysis.Thematic coding resulted in representative quotes, key words, and native concepts.Inter-rater reliability was established with the use of a codebook and agreed upon thematic definitions.Four key themes included: Subversion of End of life (EOL) Expectations; Character Development/Introspection; Exposure to Diverse Cultural/ Spiritual Perspectives; and Skills to Bring into Future Practice.Proximity to death/dying resulted in reflections on values and priorities, and a renewed sense for compassionate patient care.Students developed skills for future practice, including competency in EOL and post-mortem care, navigating difficult, emotionally laden family dynamics, and contributing to an interprofessional staff team even in uncomfortable situations.This immersion positively affected student perspectives about death and end-of-life care; creating life-altering experiences in patient-centered-care.Students stated significant impacts to employ as a physician.

AN INNOVATIVE APPROACH TO ENHANCING COPD CARE AND MANAGEMENT IN A RURAL NORTHERN COMMUNITY
Shannon Freeman 1 , Anthon Meyer 2 , Kelly Skinner 3 , and Laura Peach 3 , 1. University of Northern British Columbia, Prince George, British Columbia, Canada, 2. Northern Health Authority, Prince George, British Columbia, Canada, 3. University of Waterloo, Waterloo, Ontario, Canada Background: COPD is the third leading cause of death worldwide.Rural communities often face challenges to provide high quality chronic disease care for aging populations.Despite these longstanding challenges, there was an intention to improve the care setting by developing and fostering a shared vision for quality care, as evidenced by enhancing COPD screening and care.To ensure consistent and longitudinal patient access to high quality of care as well and ongoing physician recruitment and retention a new rural program was developed.Objective-In this presentation we will describe a new rural community based COPD program from conceptualization and development through to current functioning highlighting areas of innovation.Methods-A process evaluation guided by Moore et al.'s framework to assess program implementation, mechanisms of impact, and context was conducted.Qualitative thematic analysis was undertaken of stakeholder interviews conducted in 2021 (n=11) and document review (n=60;~500 pages) of key clinic documents dated back to pre-program development.
Results: We describe five phases of program development: Survive; Reorganize and Stabilize; Assess and Respond; Build and Refine; and Sustain and Share.Outreach and localizing resources improved access to the program.Acquiring secured physician compensation, capturing quality data, and improving patient and provider self-efficacy built the capacity of the system and stakeholders within it.Finally, relationships were forged through building an integrated facility, collaborative networking, and patient engagement.The key elements of program implementation were the resources required to ensure its operation, categorized as hardware, software, organizational, and human.

EVALUATING IMPLEMENTATION FIDELITY TO A NURSE-LED CARE MODEL IN NURSING HOMES: A MIXED-METHODS STUDY
Raphaelle Ashley Guerbaai 1 , Sabina De Geest 2 , Michael Simon 1 , Lori Popejoy 3 , Nathalie Wellens 4 , Kris Denhaerynck 1 , and Franziska Zúñiga 5 , 1.The Institute of Nursing Science,Basel,Switzerland,2. Institute of Nursing Science,Basel,Switzerland,3. University of Missouri,Columbia,Missouri,United States,4. Haute Ecole La Source,Lausanne,Vaud,Switzerland,5. University of Basel,Basel,Switzerland Implementation fidelity assesses the degree to which an intervention is delivered as intended.Little is known about how it acts as a moderator between an intervention and its intended outcome(s) and which factors affect the fidelity trajectory over time.We exemplify implementation fidelity in INTERCARE, a nurse-led care model implemented in eleven Swiss nursing homes (NH) successfully decreasing unplanned hospital transfers.A mixed-methods design was used, guided by the Conceptual Framework for Implementation Fidelity.Fidelity to INTERCARE's core components was measured with 44 self-developed items at 4-time points (baseline, 6, 12 months after intervention start, 9 months post-intervention; fidelity scores were calculated for each component and overall.Structured notes from NH meetings were used to identify moderators affecting the fidelity trajectory over time.Generalized linear mixed models were computed to analyze the quantitative data.Deductive thematic analysis was used for the qualitative analysis.The quantitative and qualitative findings were integrated using triangulation.A higher overall fidelity score showed a decreasing rate of unplanned hospital transfers (OR: 0.65 (CI=0.43-0.99),p=0.047).Higher fidelity score to advance care planning was associated with lower unplanned transfers (OR= 0.24 (CI 0.13-0.44),p= < 0.001) and a lower fidelity score for communication tools (e.g., ISBAR) to higher rates in unplanned transfers , p= < 0.003).High implementation fidelity to INTERCARE was necessary to achieve a reduction in unplanned transfers.In-house physicians with a collaborative approach and staff's perceived need for nurses working in extended roles were important factors for high fidelity.

AN INTERPROFESSIONAL APPROACH TO DEPRESCRIBING: A CURRICULAR FRAMEWORK
Winnie Sun 1 , Cheryl Sadowski 2 , and Barb Farrell 3 , 1. Ontario Tech University, Lindsay, Ontario, Canada, 2. University of Alberta,Edmonton,Alberta,Canada,3. Bruyere Continuing Care,Ottawa,Ontario,Canada Deprescribing is an important approach for managing polypharmacy and reducing harm from potentially inappropriate medications.Healthcare professionals identify barriers to deprescribing, including lack of knowledge and skill.This is not surprising as pre-licensure education does not consistently incorporate components of deprescribing into curricula.As such, there is a clear need to consider how to promote deprescribing competencies, teach related