958. A Required Infectious Diseases Rotation Improves Antimicrobial Stewardship Knowledge for Internal Medicine Interns

Abstract Background Exposure to Infectious Diseases (ID) education is highly variable in post-graduate medical training. We report our experience with a required one-week ID consult rotation for Internal Medicine (IM) interns with a focus on antimicrobial stewardship education. Methods Since 2018 all IM interns at our institution have participated in a required one-week ID consult rotation. Antimicrobial stewardship is a core feature of this rotation, with educational resources on antibiotic spectrum and decision-making, and interdisciplinary rounding with ID pharmacists. Between March 2020 and May 2021 we piloted an 11-item pre-rotation and post-rotation quiz with distinct but paired questions on key stewardship topics. The quiz was administered anonymously in SurveyMonkey. Mean pre/post rotation scores were compared using a paired T-test and the McNemar test of paired proportions was used to compare the pre/post change in percentage of correct responses for each topic. Results Among 47 interns who completed the rotation, 16 interns completed both pre- and post-rotation quizzes (response rate=34%). Mean scores on the pre-rotation quiz were 60%, compared to 77% on the post-rotation quiz (p=0.01), indicating significant improvement at the end of the rotation (Figure 1). Among 11 residents who scored below 65% on their pre-rotation quiz, all achieved an increased score on their post-rotation quiz (mean pre-test of 49% to mean post-test 79%). Table 1 displays the question topics and pre/post test change in percentage correct. The most difficult pre-test topics were ‘Recognition of AmpC-Expressing Organisms’ and ‘Antibiotics with activity against Pseudomonas aeruginosa,’ which improved, from 31% to 81% correct (p=0.03) and 50% to 100% correct (p=0.01), respectively. Figure 1. Mean score of interns on pre-rotation vs post-rotation antimicrobial stewardship quiz from March 2020 to May 2021 (n=16; p=0.01). Table 1. Question topics and change in percentage correct on pre-rotation and post-rotation quizzes. Conclusion A required one-week ID consult rotation for IM interns improved antimicrobial stewardship knowledge. Our experience may serve as a model for other institutions interested in increasing IM housestaff exposure to ID and antimicrobial stewardship. Disclosures Kristen Marks, MD, Gilead Sciences (Grant/Research Support)

Results. All sixteen learners (eight per case) completed the educational objective self-assessment surveys. The educational objectives were achieved with all questions reaching a mean response of 4 or greater indicating that the mean of learners agreed (4) or strongly agreed (5) that they were able to meet the outlined educational objectives after participating in the discussion session for Case 1 (Figure 2) and Case 2 ( Figure 3). Conclusion. Based on self-assessment surveys, our educational objectives were achieved. In turn, these first-year fellows may be better prepared to address ID consults from neurosurgical services in the future. While the case-based discussions were designed to address specific neurosurgical ID cases, our standardized framework could be adapted to a variety of surgical ID cases.
Disclosures. Molly L. Paras, MD, Deckermed (Other Financial or Material Support, Payment for book chapter) Background. Chagas disease (CD) is underdiagnosed in the United States due to limited healthcare provider awareness of the disease. Improving provider CD knowledge is important because >200,000 people living in the US are estimated to have CD, and 20-30% of those will develop related cardiac or gastrointestinal disease. People with HIV (PWH) and CD additionally are at risk for CD reactivation, which carries a >70% mortality rate.

Evaluation of Chagas Disease Knowledge Among Providers
Methods. The overall objective of this quality improvement project was to improve provider knowledge of CD prior to implementation of a CD screening initiative at a large HIV clinic in Houston, TX where >5,000 PWH are seen annually (~60% Latinx). We administered the survey to providers at this clinic before and after a 1-hour CD educational session, which included information about CD epidemiology, risk factors, transmission, screening, diagnostic strategies, and available treatments.
Results. Of 33 providers who took the pre-survey (16 faculty, 14 fellows, and 3 medical students), 27 (81.8%) completed all questions. Of 21 providers who took the post-survey (12 faculty, 6 fellows, and 3 medical students), 19 (90.5%) completed all questions. We identified the following CD knowledge gaps (i.e., questions initially answered incorrectly by >25% in the pre-educational session survey): CD transmission, regions of CD endemicity, CD risk factors, organ systems impacted by CD in PWH, and CD testing/follow-up procedures. In the post-educational session survey, we observed significant improvement in providers' knowledge of CD epidemiology (correct selection of estimated number of people living with CD in the US improved from 26.7% to 90.5%, Fisher's exact p< 0.0001), transmission (correct selection of "mother-to-child" answer improved from 73.3% to 100%, p=0.0150), and selection of correct CD testing answers improved from 51.9% to 85%, p=0.0286.

Conclusion.
Improved CD awareness among healthcare providers and reliable systematic screening protocols are important in at-risk populations. Through simple administration of a 1-hour educational session, we identified and improved several CD knowledge gaps. We noted significant improvement in providers' confidence in their CD knowledge, specifically in epidemiology, transmission, and diagnostic and screening testing.
Disclosures. All Authors: No reported disclosures Background. Exposure to Infectious Diseases (ID) education is highly variable in post-graduate medical training. We report our experience with a required one-week ID consult rotation for Internal Medicine (IM) interns with a focus on antimicrobial stewardship education.

A Required Infectious Diseases Rotation Improves Antimicrobial
Methods. Since 2018 all IM interns at our institution have participated in a required one-week ID consult rotation. Antimicrobial stewardship is a core feature of this rotation, with educational resources on antibiotic spectrum and decision-making, and interdisciplinary rounding with ID pharmacists. Between March 2020 and May 2021 we piloted an 11-item pre-rotation and post-rotation quiz with distinct but paired questions on key stewardship topics. The quiz was administered anonymously in SurveyMonkey. Mean pre/post rotation scores were compared using a paired T-test and the McNemar test of paired proportions was used to compare the pre/post change in percentage of correct responses for each topic.
Results. Among 47 interns who completed the rotation, 16 interns completed both pre-and post-rotation quizzes (response rate=34%). Mean scores on the pre-rotation quiz were 60%, compared to 77% on the post-rotation quiz (p=0.01), indicating significant improvement at the end of the rotation (Figure 1). Among 11 residents who scored below 65% on their pre-rotation quiz, all achieved an increased score on their post-rotation quiz (mean pre-test of 49% to mean post-test 79%). Table 1 displays the question topics and pre/post test change in percentage correct. The most difficult pretest topics were 'Recognition of AmpC-Expressing Organisms' and ' Antibiotics with activity against Pseudomonas aeruginosa, ' which improved, from 31% to 81% correct (p=0.03) and 50% to 100% correct (p=0.01), respectively.  Background. The incorporation of effective treatments is critical to improving patient care for COVID-19. We assessed the educational impact of a series of continuing medical education (CME) activities on knowledge, competence, and confidence changes in US and OUS physicians related to the use of monoclonal antibodies (mAbs) for COVID-19.
Methods. 10 online, CME-certified activities were delivered in multiple formats. For individual activities, educational effect was assessed with a repeated pairs pre-/ post-assessment study including a 1 to 7-item, multiple choice, knowledge/competence questionnaire and one confidence assessment question. To assess changes in knowledge, competence, and confidence, data were aggregated across activities and stratified by learning theme. McNemar's test or paired samples t-test (P< .05) assessed educational effect. The activities launched between November 2020 and May 2021; data were collected through May 2021.
Results. To date, the 10 activities have reached over 50,000 clinicians, including 24,627 physicians. Selected improvement/reinforcement in knowledge/competence measured as relative % change in correct responses pre/post education across the learning themes are reported. (i) 89% improvement/reinforcement among US ID specialists in knowledge/competence incorporating mAbs into patient care and 83% improvement among outside the US (OUS) ID specialists (P < .001). (ii) 70% improvement/reinforcement among US PCPs in knowledge/competence incorporating mAbs into patient care and 55% improvement among OUS PCPs (P < .001). (iii) 52% improvement/reinforcement in knowledge/competence among US PCPs regarding clinical data for mAbs and 44% among OUS PCPs (P < .001). (iv) 42% of US ID specialists and 29% of OUS ID specialists had a measurable improvement in confidence in identifying patients who would benefit from mAbs (P < .001).
Conclusion. This series of online, CME-certified educational activities resulted in significant improvements in knowledge, competence, and confidence regarding the appropriate use of mAbs for SARS-CoV-2 in clinical practice. These results demonstrate the effectiveness of global curriculum-based education for clinicians designed to address specific gaps in care.
Disclosures. All Authors: No reported disclosures Background. ID specialists often function as leaders of IPAC for healthcare systems, with variable training. Our graduates have noted feeling underprepared for this role despite completion of a computer-based training course on IPAC basics. We developed a 2-4 week IPAC elective (IPACe) rotation to address this gap to increase familiarity with key IPAC concepts, introduce learners to approaches to IPAC investigations, and develop understanding of common IPAC challenges and controversies.

Creation of an Infection Prevention and Control (IPAC) Elective for Infectious Disease (ID) Fellows
Methods. Methodology followed Kern's 6-step approach. A reading list focusing on key areas in infection prevention was developed. Instructional methods included flipped classroom, learner led discussions, performing tracers, and integration with the IPAC team. Key hospital processes including High Level Disinfection (HLD) and Sterile Processing Department (SPD) were reviewed in detail with and observed by learners. In addition to an IPACe, periodic required IPAC essay questions on realworld investigations as they arose were delivered to the learners. Learner Assessment: Learners were assessed on elements of IPAC consistent with the ACGME 6 core competencies at the end of their rotation. Program Assessment: Anonymous narrative feedback was solicited post rotation completion and at semi-annual program evaluations. Additionally, learners were asked to rate the elective on a 5 point Likert scale (1 lowest, 5 highest) and specific feedback was solicited for improvement. Finally, feedback was solicited from graduates in IPAC roles.
Results. 8 learners participated over from 2017-2021: 2 for 4 weeks, and 6 for 2 weeks. 4 of 8 surveys included a response to the questionnaire, all survey respondents (4/4) rated the elective 5: "rotation should be required of all trainees in the program. " Narrative assessments revealed the elective was highly valuable. Graduates reported feeling well-prepared after the IPACe for their roles as IPAC leaders. Highlights identified were: exposure to interdisciplinary teamwork, participation in tracers in identifying gaps, and using real-world IPAC challenges as cognitive frameworks for outbreak investigation.
Conclusion. An IPACe was highly valued by fellow learners and narrative assessments identified key areas for further focus.
Disclosures. All Authors: No reported disclosures