JayHawk , Wildcat and Tiger Encounters During Teaching Rounds:

1. JayHawk, Wildcat and Tiger Encounters During Teaching Rounds: Effect of Risk Reduction Strategies in an Academic Health Center Hawk, J1,2, second author last name, first initialsuperscripted affiliations, next author same way, senior author last name, Initial1,3 University of Kansas School of Medicine, Kansas City, Kansas Department of Internal Medicine1; Center for the Study of Cartoon Ornithology2; Department of Mammalian Physiology & Behavior, Division of Large Feline Studies3 Background Variables Figure 1: Percentage of residents involved in at least one feline/cartoon-bird altercation by level of training in lntervention and Control Groups • Inherent danger exists wherever bird species are in the presence of mammalian predators • Large feline predators are known to present increased risk, particular to hawk species but also to other felines in the vicinity • Hawk claws can also inflict injuries on cats • It is unknown whether interventional strategies are effective in reducing risk for injury • Primary outcome measures: hospitalization or emergency room visit for injury derived from a feline-vs-cartoon bird altercation • Secondary outcomes: severity of injury (e.g., minor laceration versus life-threatening wound); instigator (feline vs cartoon bird) as defined by first-hand witness reports by unbiased persons • Covariates: duration of residence in relevant State during formative years; collegiate-level athletic involvement (1-6 point scale reflecting the total number of years on athletic teams), age ResearchQuestions Analysis • Can a risk reduction intervention developed in the wild by successfully deployed in academic teaching hospitals where hawks, wildcats, and tigers must co-exist? • Descriptive statistics for all outcome measures and covariates • Bivariate testing for association between hospitalization/ER use and intervention versus control group, using Chi square test • Multivariable logistic regression model to determine the risk of hospitalization/ER use in the intervention group versus control group, stratified by year of training (PGY1, 2, or 3) and adjusted for instigator, years of collegiate-level athletic involvement, and age. Conclusions • In this sample, risk for large feline/cartoon bird injuries was reduced by 40% by an active risk reduction intervention. • However, risk for injury was noted to be lower as PGY year increased for both the treatment and control arms; this may suggest that acclimation to initially aversive species occurs over time throughout the passage of time during residency. Study Design • Randomized, un-blinded trial in which eight academic teams were randomized to receive the active intervention versus a control activity • Active intervention: declawing of felines, use of a frequent feeding schedule, and gradual felines desensitization to cartoon bird images • Control condition: supervised social mixers for all species every eight weeks Results • There were 100 episodes of large feline/cartoon-bird altercations documented during the study time-frame among 80 total residents • 40 were non-injury altercations (feathers ruffled in cartoon birds; hackles raised in cats, with or without witnessed hissing) • 60 altercations resulted in urgent health care utilization: • 50 ER visits not resulting in admission • 30 for minor lacerations, treated/ & released • 10 hospitalizations, one to the ICU • Cartoon birds (52%) and felines (48%) were equally likely to be in the instigator of the altercation (p=0.72) • Intervention recipients were less likely to be involved in an injurious altercation compared to control group: • Adjusted Hazard Ratio =0.60; 95%CI 0.5-0.7 Limitations • Non-blinded design, randomized at team level • Cross-contamination of the intervention into control residents may have occurred • Single academic center in the Midwest Study Sample • Internal Medicine PGYs 1, 2, and 3 during 2001-2011 academic year (n=120) • Exclusion criteria: history of transfer between universities during undergraduate education, or age over 40 years Future Directions • Other specialties (e.g., surgery) should be studies • Cost-effectiveness must be determined Supported in part by the Office of Scholarly, Academic and Research Mentoring (OSARM), Department of Internal Medicine