bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimizing the Implementation of Practice Improvement Modules in Training: Lessons from Educators
Authors: Bernabeo Elizabeth , Hood Sarah , Iobst William , Holmboe Eric , Caverzagie Kelly
Published: July 2013

Background

The American Board of Internal Medicine approved the use of Practice Improvement Modules (PIMs) to help training programs teach and assess practice-based learning and improvement (PBLI) and systems-based practice (SBP).

Methods

We surveyed individuals who ordered a PIM in a residency or fellowship training program between June 2006 and August 2009. The 43 programs that volunteered to participate completed a 30-minute anonymous online survey.

Results

Program directors or associate program directors led the PIM process in 30 programs (70%). Trainees' degrees of involvement in PIMs were highly variable between programs, and several respondents felt that trainees were either not sufficiently engaged or not engaged with enough consistency. The most common activity for trainee involvement was data collection through patient surveys or chart review, although only 17 programs (40%) provided protected time for this activity. Few trainees participated in higher level activities such as data analysis or identification for areas of improvement or were given leadership roles; yet most respondents reported that completing the PIM helped trainees learn basic principles of QI and develop competence in PBLI and SBP and that PIM completion improved the program's ability to develop QI initiatives and resulted in program or institutional improvements, including sustainable improvement in patient care. Most respondents reported that the outcome warranted the effort to complete PIMs.

Conclusions

PIMs may be a valuable but underused educational experience for trainees as well as training programs. Focusing on particular themes and facets of PIMs may facilitate implementation.
System-Based Approach to Educating Internal Medicine Residents on Preventable Hospital Readmissions
Authors: Njeim Mario , Chiha Maguy , Whitehouse Sarah , Baker-Genaw Kimberly
Published: July 2013

Background

A literature gap exists in educating internal medicine residents about hospital readmissions and how to prevent them.

Intervention

The study aimed to implement a readmissions education initiative for general internal medicine inpatient resident teams in 3 general practice units at an urban, tertiary hospital.

Methods

Senior residents were given access to a daily list of readmissions, used a readmission assessment tool to investigate causes and to assess whether each readmission was preventable, led a monthly general practice unit team meeting to discuss each case, and presented their findings at the monthly multidisciplinary readmissions meeting for additional feedback. For program evaluation, we hypothesized that the “preventable” readmissions count tracked via the readmissions assessment tool would increase as residents became better educated on the root causes of readmissions. We also conducted a survey to assess perception of the readmissions education initiative.

Results

“Preventable” readmissions increased from 21% for the first 3 months of the intervention (September–November 2010) to 46% for the most recent 3 months (January–March 2011). The survey showed that 98% (41 of 42) of respondents who had attended a multidisciplinary readmissions meeting felt involved in an effort to review or improve the rate of hospital readmissions, whereas only 40% (21 of 53) of the group that never attended a session shared the same answer.

Conclusions

This initiative required few resources, and it appeared to help residents identify “preventable” reasons for readmissions, as well as increased their perceptions of being actively involved in reducing hospital readmissions. The intervention was not associated with a statistically significant reduction in readmissions, which may be influenced primarily by multiple factors outside residents' control.
Developing a Career in Global Health: Considerations for Physicians-in-Training and Academic Mentors
Authors: Nelson Brett D. , Kasper Jennifer , Hibberd Patricia L. , Thea Donald M. , Herlihy Julie M.
Published: July 2013

Background

Global health is an expansive field, and global health careers are as diverse as the practice of medicine, with new paths being forged every year. Interest in global health among medical students, residents, and fellows has never been higher. As a result, a greater number of these physicians-in-training are participating in global health electives during their training. However, there is a gap between the level of trainee interest and the breadth and depth of educational opportunities that prepare them for a career in global health.

Objective

Global health experiences can complement and enhance each step of traditional physician training, from medical school through residency and fellowship. Global health experiences can expose trainees to patients with diverse pathologies, improve physical exam skills by decreasing reliance on laboratory tests and imaging, enhance awareness of costs and resource allocation in resource-poor settings, and foster cultural sensitivity. The aim of this article is to describe issues faced by physicians-in-training and the faculty who mentor them as trainees pursue careers in global health.

Methods

We conducted a narrative review that addresses opportunities and challenges, competing demands on learners' educational schedules, and the need for professional development for faculty mentors.

Conclusions

A widening gap between trainee interest and the available educational opportunities in global health may result in many medical students and residents participating in global health experiences without adequate preparation and mentorship. Without this essential support, global health training experiences may have detrimental consequences on both trainees and the communities hosting them. We discuss considerations at each training level, options for additional training, current career models in global health, and challenges and potential solutions during training and early career development.
Anesthesiology Residents-as-Teachers Program: A Pilot Study
Authors: Berger Jeffrey S. , Daneshpayeh Negin , Sherman Marian , Gaba Nancy , Keller Jennifer , Perel Leon , Blatt Benjamin , Greenberg Larrie
Published: July 2013

Background

The role of residents as teachers has grown over time. Programs have been established within various specialties to formally develop these skills. Anesthesiology residents are frequently asked to provide supervision for novice learners and have numerous opportunities for teaching skills and clinical decision making. Yet, there are no educational programs described in the literature to train anesthesiology residents to teach novice learners.

Objective

To explore whether a resident-as-teacher program would increase anesthesiology residents' self-reported teaching skills.

Methods

An 8-session interactive Anesthesiology Residents-as-Teachers (ART) Program was developed to emphasize 6 key teaching skills. During a 2-year period, 14 anesthesiology residents attended the ART program. The primary outcome measure was resident self-assessment of their teaching skills across 14 teaching domains, before and 6 months after the ART program. Residents also evaluated the workshops for quality with a 9-item, postworkshop survey. Paired t testing was used for analysis.

Results

Resident self-assessment led to a mean increase in teaching skills of 1.04 in a 5-point Likert scale (P < .001). Residents reported the greatest improvement in writing/using teaching objectives (+1.29, P < .001), teaching at the bedside (+1.57, P  =  .002), and leading case discussions (+1.64, P  =  .001). Residents rated the workshops 4.2 out of 5 (3.9–4.7).

Conclusions

Residents rated their teaching skills as significantly improved in 13 of 14 teaching domains after participation in the ART program. The educational program required few resources and was rated highly by residents.
Love Letters: An Anthology of Constructive Relationship Advice Shared Between Junior Mentees and Their Mentors
Authors: Gillespie Suzanne M. , Thornburg Loralei L. , Caprio Thomas V. , Medina-Walpole Annette
Published: July 2013

Mentorship is critical to the professional success of physicians, physicians-in-training, and junior faculty in academic practice. There are challenges to being a thoughtful and effective mentor and to being an engaged mentee. Many physicians and physicians-in-training cite difficulty finding professional time to dedicate to building their mentoring relationships, particularly given demanding clinical workloads and competing time commitments. Therefore, making the most out of the time in mentoring relationships is key to success. We present a collection of frustrations and good advice that have been passed between mentees and mentors on improving the mentor-mentee relationship. The information was compiled from actual interactions between mentors and mentees, and these “love letters” draw on complex associations, which like any “committed” relationship require constant reevaluation and discussion to bring them to their full potential.
An Observational Study of Hospital Paging Practices and Workflow Interruption Among On-Call Junior Neurological Surgery Residents
Authors: Fargen Kyle M. , O'Connor Timothy , Raymond Steven , Sporrer Justin M. , Friedman William A.
Published: July 2013

Background

Previous studies suggest that nonurgent pages comprise a substantial portion of the pages received by residents while on duty. We evaluated the number, type, and urgency of pages received and the task being performed at the time of paging by on-call junior neurosurgery residents at a large teaching hospital, with the aim of providing insight into mechanisms that can be developed to improve paging patterns and ultimately reduce physician distractions due to nonurgent communications.

Methods

For eight 12-hour call sessions, a medical student shadowed the on-call junior neurosurgery resident and recorded all pages received and the time, paging number and location, priority of the page (nonurgent, urgent, or emergency), and the activity the resident performed when the page was received. During one 5-hour session, a recorder measured the amount of time spent returning pages.

Results

During the study period, 439 communications were recorded (mean of 54.9 per 12-hour session; range, 33–75). Communications occurred at a rate of every 13 minutes and ranged from every 34 minutes to every 8.7 minutes. Paging remained frequent even during the hours when on-call residents are most likely to sleep (2–5 am), with an average of 4 communications per hour. The time to return pages ranged from 15 to 174 seconds (mean, 79.7 seconds). Most pages were nonurgent (68.3%) and occurred during patient care activities (65%).

Conclusions

Paging communications were frequent. Most pages were nonurgent and were received during important patient care activities. This suggests that a viable solution must address the work context of the individual being paged and the individual initiating the page to ensure that urgent communications are properly prioritized and attended to.
Quality and Safety Training in Primary Care: Making an Impact
Authors: Byrne John M. , Hall Susan , Baz Sam , Kessler Todd , Roman Maher , Patuszynski Mark , Thakkar Kruti , Kashner T. Michael
Published: July 2013

Purpose

Preparing residents for future practice, knowledge, and skills in quality improvement and safety (QI/S) is a requisite element of graduate medical education. Despite many challenges, residency programs must consider new curricular innovations to meet the requirements. We report the effectiveness of a primary care QI/S curriculum and the role of the chief resident in quality and patient safety in facilitating it.

Method

Through the Veterans Administration Graduate Medical Education Enhancement Program, we added a position for a chief resident in quality and patient safety, and 4 full-time equivalent internal medicine residents, to develop the Primary Care Interprofessional Patient-Centered Quality Care Training Curriculum. The curriculum includes a first-or second-year, 1-month block rotation that serves as a foundational experience in QI/S and interprofessional care. The responsibilities of the chief resident in quality and patient safety included organizing and teaching the QI/S curriculum and mentoring resident projects. Evaluation included prerotation and postrotation surveys of self-assessed QI/S knowledge, abilities, skills, beliefs, and commitment (KASBC); an end-of-the-year KASBC; prerotation and postrotation knowledge test; and postrotation and faculty surveys.

Results

Comparisons of prerotation and postrotation KASBC indicated significant self-assessed improvements in 4 of 5 KASBC domains: knowledge (P < .001), ability (P < .001), skills (P < .001), and belief (P < .03), which were sustained on the end-of-the-year survey. The knowledge test demonstrated increased QI/S knowledge (P  =  .002). Results of the postrotation survey indicate strong satisfaction with the curriculum, with 76% (25 of 33) and 70% (23 of 33) of the residents rating the quality and safety curricula as always or usually educational. Most faculty members acknowledged that the chief resident in quality and patient safety enhanced both faculty and resident QI/S interest and participation in projects.

Conclusions

Our primary care QI/S curriculum was associated with improved and persistent resident self-perceived knowledge, abilities, and skills and increased knowledge-based scores of QI/S. The chief resident in quality and patient safety played an important role in overseeing the curriculum, teaching, and providing leadership.
Essential Facets of Competence That Enable Trust in Graduates: A Delphi Study Among Physician Educators in the Netherlands
Authors: Wijnen-Meijer Marjo , van der Schaaf Marieke , Nillesen Kirstin , Harendza Sigrid , ten Cate Olle
Published: July 2013

Background

There is a need for valid methods to assess the readiness for clinical practice of recently graduated physicians. To develop these methods, it is relevant to know the general features of trainees' performance that facilitate supervisors' trust in their ability to perform critical clinical tasks.

Objective

To discover such essential facets of competence (FOCs), based on the opinion of experienced physician educators.

Methods

We conducted a Delphi study, consisting of 2 rounds, among 18 experienced physician educators in the Netherlands. Mean, standard deviation, level of agreement, and skewness were calculated for the importance of FOCs for making entrustment decisions. The study yielded a list of 25 FOCs.

Results

In the first round, means were between 6.50 and 7.00 on a 7-point Likert scale (SD, 0.42–2.18); in the second round, means ranged from 5.45 to 6.90 (SD, 0.3–2.02). The level of agreement was high for 92% of the FOCs in the first round and 100% of the FOCs in the second round.

Conclusions

Our Delphi study found consensus among experts about FOCs that are important for clinical entrustment decisions.
Pilot Study of iPad Incorporation Into Graduate Medical Education
Authors: Lobo Mark J. , Crandley Edwin F. , Rumph Jake S. , Kirk Susan E. , Dunlap Neal E. , Rahimi Asal S. , Turner A. Benton , Larner James M. , Read Paul W.
Published: July 2013

Background

Increased documentation and charting requirements are challenging for residents, given duty hour limits. Use of mobile electronic devices may help residents complete these tasks efficiently.

Objective

To collect initial data on usage rates, information technology (IT) support requirements, and resident use of iPads during training.

Methods

In this pilot study, we provided 12 residents/fellows from various specialties at the University of Virginia with an iPad with IT support. The system used a virtual private network with access to the institution's electronic health record. Participants were allowed to develop their own methods and systems for personalized iPad use, and after 9 months they provided data on the utility of the iPad. Feedback from the IT team also was obtained.

Results

Average iPad use was 2.1 h/d (range, 0.5–6 h/d). The average self-reported reduction in administrative work due to the iPad was 2.7 h/wk (range, 0–9 h/wk). A total of 75% (9 of 12) of the users would recommend universal adoption among residents and fellows. More than 90% (11 of 12) of users reported the iPad would improve communication for coordination of care. A total of 68% (8 of 12) of users reported that an iPad facilitated their activities as educators of medical students and junior residents. Residents cited slow data entry into the electronic health record and hospital areas lacking Wi-Fi connectivity as potential drawbacks to iPad use. The IT team reported minimal support time for device setup, maintenance, and upgrades, and limited security risks.

Conclusions

The iPad may contribute to increased clinical efficiency, reduced hours spent on administrative tasks, and enhanced educational opportunities for residents, with minimal IT support.
An Experiential Community Orientation to Improve Knowledge and Assess Resident Attitudes Toward Poor Patients
Authors: Wallace Erik A. , Miller-Cribbs Julie E. , Duffy F. Daniel
Published: July 2013

Background

Future physicians may not be prepared for the challenges of caring for the growing population of poor patients in this country. Given the potential for a socioeconomic “gulf” between physicians and patients and the lack of curricula that address the specific needs of poor patients, resident knowledge about caring for this underserved population is low.

Intervention

We created a 2-day Resident Academy orientation, before the start of residency training, to improve community knowledge and address resident attitudes toward poor patients through team-based experiential activities. We collected demographic and satisfaction data through anonymous presurvey and postsurvey t tests, and descriptive analysis of the quantitative data were conducted. Qualitative comments from open-ended questions were reviewed, coded, and divided into themes. We also offer information on the cost and replicability of the Academy.

Results

Residents rated most components of the Academy as “very good” or “excellent.” Satisfaction scores were higher among residents in primary care training programs than among residents in nonprimary care programs for most Academy elements. Qualitative data demonstrated an overall positive effect on resident knowledge and attitudes about community resource availability for underserved patients, and the challenges of poor patients to access high-quality health care.

Conclusions

The Resident Academy orientation improved knowledge and attitudes of new residents before the start of residency, and residents were satisfied with the experience. The commitment of institutional leaders is essential for success.
Systems-Based Content in Medical Morbidity and Mortality Conferences: A Decade of Change
Authors: Gonzalo Jed D. , Yang Julius J. , Huang Grace C.
Published: July 2013

Background

Following the Accreditation Council for Graduate Medical Education recommendations in 1999 to foster education in the systems-based practice (SBP) competency by examining adverse clinical events, institutions have modified the morbidity and mortality conference (MMC) to increase SBP-related discussion. We sought to examine the extent to which SBP-related content has increased in our department's MMCs compared with MMCs 10 years prior.

Method

We qualitatively analyzed audio recordings of our MMCs during 2 academic years, 1999–2000 (n  =  30) and 2010–2011 (n  =  30). We categorized comments and questions from moderators and faculty as SBP or non-SBP and characterized conferences by whether adverse events were presented and which systems issues were discussed.

Results

Compared with MMCs in 1999–2000, present-day MMCs included a greater average percentage of SBP comments stated (69% versus 12%; P ≤ .001) and questions asked (13% versus 1%; P  =  .001) by the moderator, SBP comments stated (44% versus 4%; P ≤ .001) and questions asked (19% versus 1%; P ≤ .001) by faculty, and were more likely to present adverse events (87% versus 13%; P < .001). Interrater reliability for the distinction between SBP and non-SBP content was good (κ  =  0.647). Most common categories of systems issues discussed in 2010–2011 were critical laboratory value processing and reporting, institutional policies, and hospital-based factors.

Conclusions

Over the past decade, our MMC has transformed to include more discussion of SBP-related content and adverse events. The MMC can be used to educate residents in SBP and can also serve as a cornerstone for departmental quality and safety initiatives.
Interns' Experiences of Disruptive Behavior in an Academic Medical Center
Authors: Mullan Charles P. , Shapiro Jo , McMahon Graham T.
Published: July 2013

Background

The first year of graduate medical education is an important period in the professional development of physicians. Disruptive behavior interferes with safe and effective clinical practice.

Objective

To determine the frequency and nature of disruptive behavior perceived by interns and attending physicians in a teaching hospital environment.

Method

All 516 interns at Partners HealthCare (Boston, MA) during the 2010 and 2011 academic years were eligible to complete an anonymous questionnaire. A convenience nonrandom sample of 40 attending physicians also participated.

Results

A total of 394 of 516 eligible interns (76.4%) participated. Attendings and interns each reported that their team members generally behaved professionally (87.5% versus 80.4%, respectively). A significantly greater proportion of attendings than interns felt respected at work (90.0% versus 71.5% respectively; P  =  .01). Disruptive behavior was experienced by 93% of interns; 54% reported that they experienced it once a month or more. Interns reported disruptive behavior significantly more frequently than attending physicians, including increased reports of condescending behavior (odds ratio [OR], 5.46 for interns compared with attendings; P < .001), exclusion from decision making (OR, 6.97; P < .001), and berating (OR, 4.84; P  =  .02). Inappropriate jokes, abusive language, and gender bias were also reported, and they were not significantly more frequent among interns than attending physicians. Interns most frequently identified nurses as the source of disruption, and were significantly more likely than faculty to identify nurses as the source of disruptive behavior (OR, 10.40; P < .001). Attendings reported other physicians as the most frequent source of disruption.

Conclusions

Although interns generally feel respected at work, they frequently experience disruptive behavior. Interns described more disruptive behaviors than a convenience sample of attending physicians at our institution.
“If You Build It, They Will Come”: Attitudes of Medical Residents and Fellows About Seeking Services in a Resident Wellness Program
Authors: Ey Sydney , Moffit Mary , Kinzie J. Mark , Choi Dongseok , Girard Donald E.
Published: July 2013

Background

High rates of burnout and distress in resident physicians suggest a significant number would benefit from counseling.

Intervention

A resident wellness program (RWP) was designed to lower known barriers limiting resident access to services.

Methods

In 2011, medical residents and fellows were surveyed and logistic regression analyses were conducted to identify demographic and training program differences in perceived barriers and willingness to access the RWP.

Results

Of the 88% of trainees who knew about the RWP, 87% indicated they would be very likely or somewhat likely to seek out services. Time remained the biggest barrier for residents to getting help. Being male (odds ratio [OR]  =  0.54, 95% confidence interval [CI] 0.34–0.84) or an ethnic/racial minority (OR  =  0.49, 95% CI 0.28–0.85) was associated with greater unwillingness to seek counseling. Reluctance to access the RWP was associated with concerns about helpfulness, confidentiality, being unable to take a break, and stigma. Women (OR  =  1.60, 95% CI 1.06–2.42) and primary care residents (OR  =  1.58, 95% CI 0.98–2.54) were more likely to be concerned about taking a break. Men were more likely to question the helpfulness of counseling (OR  =  0.55, 95% CI 0.36–0.85).

Conclusions

The RWP removed barriers of cost and knowledge about counseling services. More educational outreach is needed to address sex and ethnic differences about RWP utilization and attitudes in medical culture about a physician's right to address personal health care needs.
Validation of an Evidence-Based Medicine Critically Appraised Topic Presentation Evaluation Tool (EBM C-PET)
Authors: Kersten Hans B. , Frohna John G. , Giudice Erin L.
Published: July 2013

Background

Competence in evidence-based medicine (EBM) is an important clinical skill. Pediatrics residents are expected to acquire competence in EBM during their education, yet few validated tools exist to assess residents' EBM skills.

Objective

We sought to develop a reliable tool to evaluate residents' EBM skills in the critical appraisal of a research article, the development of a written EBM critically appraised topic (CAT) synopsis, and a presentation of the findings to colleagues.

Methods

Instrument development used a modified Delphi technique. We defined the skills to be assessed while reviewing (1) a written CAT synopsis and (2) a resident's EBM presentation. We defined skill levels for each item using the Dreyfus and Dreyfus model of skill development and created behavioral anchors using a frame-of-reference training technique to describe performance for each skill level. We evaluated the assessment instrument's psychometric properties, including internal consistency and interrater reliability.

Results

The EBM Critically Appraised Topic Presentation Evaluation Tool (EBM C-PET) is composed of 14 items that assess residents' EBM and global presentation skills. Resident presentations (N  =  27) and the corresponding written CAT synopses were evaluated using the EBM C-PET. The EBM C-PET had excellent internal consistency (Cronbach α  =  0.94). Intraclass correlation coefficients were used to assess interrater reliability. Intraclass correlation coefficients for individual items ranged from 0.31 to 0.74; the average intraclass correlation coefficients for the 14 items was 0.67.

Conclusions

We identified essential components of an assessment tool for an EBM CAT synopsis and presentation with excellent internal consistency and a good level of interrater reliability across 3 different institutions. The EBM C-PET is a reliable tool to document resident competence in higher-level EBM skills.
Constructing a Novel Simple LEEP Training Model
Authors: Walters Christen L. , Whitworth Jenny M. , Tyra Sharon L. , Walsh-Covarrubias Julie B. , Straughn J. Michael
Published: July 2013

Background

Duty hour restrictions and enhanced focus on patient safety have prompted the development of new instruction models for practice of surgical techniques outside the operating room, including models for teaching loop electrosurgical excisional procedure (LEEP), a common procedure that gynecology residents perform to diagnose and manage cervical disease.

Objective

We sought to develop an inexpensive and reusable training model for guided practice opportunities that will improve gynecology residents' LEEP technique.

Methods

Polyvinyl chloride, foam, and a polish sausage are used to simulate the basic anatomy of the vagina and cervix. A 2-in-diameter polyvinyl chloride pipe and high-density foam are used to create a realistic representation with the sausage simulating the cervix. An electrosurgical pad is attached to the sausage and a standard operating room electrosurgical generator is used.

Results

After a brief lecture and demonstration of the LEEP procedure, gynecology residents are positioned at individual stations. Use of 2 to 3 instructors allows for the provision of directions and feedback to residents as they perform the simulated LEEP. During the last 6 years, this model has continued to improve residents' confidence and skills with the procedure.

Conclusions

An anatomically accurate LEEP model can not only improve resident knowledge, skills, and confidence, but also improve quality and patient safety. This training model allows residents to refine their surgical skills through guided practice and instructors to monitor performance before residents to perform the procedure on patients.
Effect of a Multidisciplinary-Assisted Resident Diabetes Clinic on Resident Knowledge and Patient Outcomes
Authors: Lo Margaret C. , Freeman Morganna , Lansang M. Cecilia
Published: July 2013

Background

Despite the rising prevalence of diabetes, there is a paucity of diabetes curricula in residency training. The multidisciplinary diabetes team approach is underused in residency education.

Objective

To assess the feasibility of an innovative multidisciplinary resident diabetes clinic (MRDC) in enhancing (1) resident diabetes knowledge via a Diabetes Awareness Questionnaire, and (2) subsequent process and patient outcomes in patients with diabetes via a Diabetes Practice Behavior Checklist.

Methods

From October 2008 to February 2010, 14 internal medicine residents managed patients with uncontrolled diabetes in a weekly half-day MRDC for 1 month (total 4–5 half-day sessions/resident), with a collaborative team of internists, diabetes educators, an endocrinologist, and a pharmacist. The curriculum included didactic sessions, required readings, and patient-specific case discussions. A 20-question Diabetes Awareness Questionnaire was administered to each resident prerotation and postrotation. Records of 47 patients with diabetes in the residents' own continuity clinics (not the MRDC) were audited 6 months before and after the MRDC for Diabetes Practice Behavior Checklist measures (glycated hemoglobin, blood pressure, low-density lipoprotein cholesterol, retinal referral, foot exam, microalbumin screen). Pre-MRDC and post-MRDC data were compared via paired t test.

Results

The MRDC residents exhibited a modest increase in mean (SD) scores on the Diabetes Awareness Questionnaire (before, 8.2 [2.8]; after, 10.9 [2.8]; P  =  .02) and a modest mean (SD) performance increase in overall process outcomes from the Diabetes Practice Behavior Checklist (before, 74% [18%]; after, 84% [18%]; P  =  .004). No improvements occurred in patient outcomes.

Conclusions

Multidisciplinary diabetes teaching may be useful in fostering certain resident knowledge and performance measures but may not alter clinical outcomes. Further large-scale, longitudinal studies are needed to understand the effect of our curriculum on residents' diabetes knowledge and future practice behavior.
Enablers of and Barriers to Abortion Training
Authors: Guiahi Maryam , Lim Sahnah , Westover Corey , Gold Marji , Westhoff Carolyn L.
Published: July 2013

Background

Since the legalization of abortion services in the United States, provision of abortions has remained a controversial issue of high political interest. Routine abortion training is not offered at all obstetrics and gynecology (Ob-Gyn) training programs, despite a specific training requirement by the Accreditation Council for Graduate Medical Education. Previous studies that described Ob-Gyn programs with routine abortion training either examined associations by using national surveys of program directors or described the experience of a single program.

Objective

We set out to identify enablers of and barriers to Ob-Gyn abortion training in the context of a New York City political initiative, in order to better understand how to improve abortion training at other sites.

Methods

We conducted in-depth qualitative interviews with 22 stakeholders from 7 New York City public hospitals and focus group interviews with 62 current residents at 6 sites.

Results

Enablers of abortion training included program location, high-capacity services, faculty commitment to abortion training, external programmatic support, and resident interest. Barriers to abortion training included lack of leadership continuity, leadership conflict, lack of second-trimester abortion services, difficulty obtaining mifepristone, optional rather than routine training, and antiabortion values of hospital personnel.

Conclusions

Supportive leadership, faculty commitment, and external programmatic support appear to be key elements for establishing routine abortion training at Ob-Gyn residency training programs.
Cultural Competency Training Requirements in Graduate Medical Education
Authors: Ambrose Adrian Jacques H. , Lin Susan Y. , Chun Maria B. J.
Published: July 2013

Background

Cultural competency is an important skill that prepares physicians to care for patients from diverse backgrounds.

Objective

We reviewed Accreditation Council for Graduate Medical Education (ACGME) program requirements and relevant documents from the ACGME website to evaluate competency requirements across specialties.

Methods

The program requirements for each specialty and its subspecialties were reviewed from December 2011 through February 2012. The review focused on the 3 competency domains relevant to culturally competent care: professionalism, interpersonal and communication skills, and patient care. Specialty and subspecialty requirements were assigned a score between 0 and 3 (from least specific to most specific). Given the lack of a standardized cultural competence rating system, the scoring was based on explicit mention of specific keywords.

Results

A majority of program requirements fell into the low- or no-specificity score (1 or 0). This included 21 core specialties (leading to primary board certification) program requirements (78%) and 101 subspecialty program requirements (79%). For all specialties, cultural competency elements did not gravitate toward any particular competency domain. Four of 5 primary care program requirements (pediatrics, obstetrics-gynecology, family medicine, and psychiatry) acquired the high-specificity score of 3, in comparison to only 1 of 22 specialty care program requirements (physical medicine and rehabilitation).

Conclusions

The degree of specificity, as judged by use of keywords in 3 competency domains, in ACGME requirements regarding cultural competency is highly variable across specialties and subspecialties. Greater specificity in requirements is expected to benefit the acquisition of cultural competency in residents, but this has not been empirically tested.
The ACGME Duty Hour Standards and Board Certification Examination Performance Trends in Surgical Specialties
Authors: Falcone John L. , Feinn Richard S.
Published: July 2013

Background

Duty hour limitations initiated by the Accreditation Council for Graduate Medical Education (ACGME) in 2003 could improve resident education in surgical specialties.

Objective

The purpose of this study was to evaluate national surgical board examination performance and its relationship to the ACGME duty hour standards.

Methods

In this retrospective cohort study, electronically published website content was evaluated for examination statistics for the 10 surgical boards in the American Board of Medical Specialties. To evaluate examination trends over time, we performed simple linear regression. We also performed interrupted time series analyses, using segmented logistic regression. The secondary analyses consisted of a χ2 test of passing and failing examinees before and after 2003. All statistics used α  =  .05.

Results

There were 8 of 10 (80%) surgical boards with examinations that met inclusion criteria and a total of 72 482 unique examination results. Of the 16 examinations evaluated (50% written, 50% oral), 13 (81%) had either significant pass rate trends on regression analyses and/or a significant pre-post pass rate surrounding the initiation of the ACGME duty hour standards in 2003 in the secondary analysis (P < .05).

Conclusions

There are both increasing examination pass rates and some downward trends in examination performance on surgical board examinations since the initiation of the ACGME duty hour standards in 2003. The etiology of these trends is unclear, but trends are important to know for individual examinees, residency training programs, and surgical boards.
Teaching Cost-Conscious Medicine: Impact of a Simple Educational Intervention on Appropriate Abdominal Imaging at a Community-Based Teaching Hospital
Authors: Covington Matthew F. , Agan Donna L. , Liu Yang , Johnson John O. , Shaw David J.
Published: July 2013

Background

Rising costs pose a major threat to US health care. Residency programs are being asked to teach residents how to provide cost-conscious medical care.

Methods

An educational intervention incorporating the American College of Radiology appropriateness criteria with lectures on cost-consciousness and on the actual hospital charges for abdominal imaging was implemented for residents at Scripps Mercy Hospital in San Diego, CA. We hypothesized that residents would order fewer abdominal imaging examinations for patients with complaints of abdominal pain after the intervention. We analyzed the type and number of abdominal imaging studies completed for patients admitted to the inpatient teaching service with primary abdominal complaints for 18 months before (738 patients) and 12 months following the intervention (632 patients).

Results

There was a significant reduction in mean abdominal computed tomography (CT) scans per patient (1.7–1.4 studies per patient, P < .001) and total abdominal radiology studies per patient (3.1–2.7 studies per patient, P  =  .02) following the intervention. The avoidance of charges solely due to the reduction in abdominal CT scans following the intervention was $129 per patient or $81,528 in total.

Conclusions

A simple educational intervention appeared to change the radiologic test-ordering behavior of internal medicine residents. Widespread adoption of similar interventions by residency programs could result in significant savings for the health care system.
Preparing Interns for Anesthesiology Residency Training: Development and Assessment of the Successful Transition to Anesthesia Residency Training (START) E-Learning Curriculum
Authors: Chu Larry F. , Ngai Lynn K. , Young Chelsea A. , Pearl Ronald G. , Macario Alex , Harrison T. Kyle
Published: July 2013

Background

The transition from internship to residency training may be a stressful time for interns, particularly if it involves a change among programs or institutions after completing a preliminary year.

Objective

We explored whether an e-learning curriculum would increase interns' preparedness for the transition to the first year of clinical anesthesiology training and reduce stress by improving confidence and perceived competence in performing professional responsibilities.

Intervention

We tested a 10-month e-learning program, Successful Transition to Anesthesia Residency Training (START), as a longitudinal intervention to increase interns' self-perceived preparedness to begin anesthesiology residency training in a prospective, observational study and assessed acceptance and sustainability. After a needs assessment, we administered the START modules to 22 interns, once a month, using an integrated learning management and lecture-capture system. We surveyed interns' self-assessed preparedness to begin anesthesiology residency before and after completing the START modules. Interns from the prior year's class, who did not participate in the online curriculum, served as controls.

Results

After participation in the START intervention, self-assessed preparedness to begin residency improved by 72% (P  =  .02). Interns also felt more connected to, and had improved positive feelings toward, their new residency program and institution.

Conclusion

Participation in our novel 10-month e-learning curriculum and virtual mentorship program improved interns' impression of their residency program and significantly increased interns' subjective assessment of their preparedness to begin anesthesiology residency. This e-learning concept could be more broadly applied and useful to other residency programs.
Burnout, Coping, and Spirituality Among Internal Medicine Resident Physicians
Authors: Doolittle Benjamin R. , Windish Donna M. , Seelig Charles B.
Published: July 2013

Background

Burnout in physicians is common, and studies show a prevalence of 30% to 78%. Identifying constructive coping strategies and personal characteristics that protect residents against burnout may be helpful for reducing errors and improving physician satisfaction.

Objective

We explored the complex relationships between burnout, behaviors, emotional coping, and spirituality among internal medicine and internal medicine-pediatrics residents.

Methods

We anonymously surveyed 173 internal medicine and medicine-pediatrics residents to explore burnout, coping, and spiritual attitudes. We used 3 validated survey instruments: the Maslach Burnout Inventory, the Carver Coping Orientation to Problems Experienced (COPE) Inventory, and the Hatch Spiritual Involvement and Beliefs Scale (SIBS).

Results

A total of 108 (63%) residents participated, with 31 (28%) reporting burnout. Residents who employed strategies of acceptance, active coping, and positive reframing had lower emotional exhaustion and depersonalization (all, P < .03). Residents who reported denial or disengagement had higher emotional exhaustion and depersonalization scores. Personal accomplishment was positively correlated with the SIBS total score (r  =  +.28, P  =  .003), as well as the internal/fluid domain (r  =  +.32, P  =  .001), existential axes (r  =  +.32, P  =  .001), and humility/personal application domain (r  =  +.23, P  =  .02). The humility/personal application domain also was negatively correlated with emotional exhaustion (r  =  −.20, P  =  .04) and depersonalization (r  =  −.25, P  =  .009). No activity or demographic factor affected any burnout domain.

Conclusions

Burnout is a heterogeneous syndrome that affects many residents. We identified a range of emotional and spiritual coping strategies that may have protective benefit.
Attrition Rates Between Residents in Obstetrics and Gynecology and Other Clinical Specialties, 2000–2009
Authors: Kennedy Kathleen A. , Brennan Matthew C. , Rayburn William F. , Brotherton Sarah E.
Published: July 2013

Background

As resident attrition disrupts educational and workload balance and reduces the number of graduating physicians to care for patients, an ongoing goal of graduate medical education programs is to retain residents.

Objective

We compared annual rates of resident attrition in obstetrics and gynecology (Ob-Gyn) with other clinical specialties of similar or larger size during a recent 10-year period, and explored the reasons for resident attrition.

Methods

In this observational study, we analyzed annual data from the American Medical Association Graduate Medical Education Census between academic years 2000 and 2009 for residents who entered Ob-Gyn and other core clinical specialties. Our primary outcome was the trend in averaged annual attrition rates.

Results

The average annual attrition was 196 ± 12 (SD) residents, representing 4.2% ± 0.5% of all Ob-Gyn residents. Rates of attrition were consistently higher among men (5.3%) and international medical school graduates (7.6%). The annual rate of attrition was similar to that for other clinical specialties (mean: 4.0%; range: from 1.5% in emergency medicine to 7.9% in psychiatry). The attrition rates for Ob-Gyn residents were relatively stable for the 10-year period (range: 3.6% in 2008 to 5.1% in 2006). Common reasons for attrition were transition to another specialty (30.0%), withdrawal/dismissal (28.2%), transfer to another Ob-Gyn program (25.4%), and leave of absence (2.2%). These proportions remained fairly constant during this 10-year period.

Conclusions

The average annual attrition rate of residents in Ob-Gyn was 4.2%, comparable to most other core clinical specialties.
A Curriculum to Improve Residents' End-of-Life Communication and Pain Management Skills During Pediatrics Intensive Care Rotation: Pilot Study
Authors: Asuncion Arsenia M. , Cagande Consuelo , Schlagle Sherry , McCarty Barbara , Hunter Krystal , Milcarek Barry , Staman Greg , Da Silva Shonola , Fisher Dixie , Graessle William
Published: July 2013

Background

Research suggests pediatrics practitioners lack confidence and skills in the end-of-life (EOL) care.

Objective

This pilot study explored the impact of a curriculum designed to prepare future pediatricians to manage pain and provide comfort for children and infants with life-threatening conditions and to be more confident and competent in their EOL discussions with families.

Methods

Participants included 8 postgraduate year (PGY)-2 residents in the study group and 9 PGY-3 residents in a control group. The EOL curriculum included 4, 1-hour sessions consisting of didactic lectures, videos, and small-group, interactive discussions. Topics included discussing EOL with families, withdrawal of care, and pain assessment and management. Curriculum evaluation used an objective structured clinical examination (OSCE), self-assessment confidence and competency questionnaire, and a follow-up survey 18 months after the intervention.

Results

The OSCE showed no statistically significant differences between PGY-2 versus PGY-3 residents in discussing EOL issues with family (mean  =  48.3 [PGY-2] versus 41.0 [PGY-3]), managing withdrawal of care (mean  =  20.9 [PGY-2] versus 18.91 [PGY-3]), and managing adolescent pain (mean  =  30.97 [PGY-2] versus 29.27 [PGY-3]). The self-assessment confidence and competency scores improved significantly after the intervention for both PGY-2 residents (0.62 versus 0.86, P < .01) and PGY-3 residents (0.61 versus 0.85, P < .01).

Conclusions

An EOL curriculum for PGY-2 pediatrics residents delivered during the intensive care unit rotation is feasible and may be effective. Residents reported the curriculum was useful in their practice.
Use of a Geriatric Quality Initiative to Educate Internal Medicine Residents about Delirium and Its Risk Factors
Authors: Ölveczky Daniele , Mattison Melissa L. P. , Mukamal Kenneth J.
Published: July 2013

Background

Delirium is a common and debilitating complication of inpatient care for many older adults, yet internal medicine residents often do not recognize delirium or its risk factors. Integrating geriatric education (eg, delirium recognition) with inpatient quality improvement (QI) is not well tested.

Methods

We developed an educational pilot program within an ongoing hospital-wide geriatric QI initiative (Global Risk Assessment and Careplan for the Elderly-Acute Care [GRACE-AC]). GRACE-AC modifies the inpatient computerized provider order entry system to meet the needs of vulnerable older adults and uses a bedside care checklist to identify patients with possible delirium and promote delirium prevention by checking on the need for “tethers” (intravenous fluids, Foley catheters, and telemetry). Residents were assessed before and after each inpatient rotation by using anonymous electronic surveys.

Results

A total of 167 eligible residents (91%) completed prerotation surveys, and 102 (56%) residents completed postrotation surveys. All but the first rotating resident group received a standardized 2-minute educational in-service orientation. In a comparison of postrotation responses before and after implementation of the in-service, the proportion of residents who reported improvement in their ability to recall which patients had tethers increased from 17% to 52% for intravenous fluids (P  =  .004), 28% to 75% for Foley catheters (P < .001), and 21% to 50% for telemetry (P  =  .02). Comparing pre- and postrotation surveys, the proportion of correct responses to questions on haloperidol dosing and the characteristics of delirium increased from 26% to 76% and 31% to 63%, respectively (both P < .001).

Conclusions

Our pilot program demonstrated that inpatient geriatric QI initiatives can be successfully merged with a brief educational curriculum.