bluuebunny/crossref_metadata_2025 huggingface dataset:
Educational Milestone Development in the First 7 Specialties to Enter the Next Accreditation System
Authors: Swing Susan R. , Beeson Michael S. , Carraccio Carol , Coburn Michael , Iobst William , Selden Nathan R. , Stern Peter J. , Vydareny Kay
Published: July 2013

Background

The Accreditation Council for Graduate Medical Education (ACGME) Outcome Project introduced 6 general competencies relevant to medical practice but fell short of its goal to create a robust assessment system that would allow program accreditation based on outcomes. In response, the ACGME, the specialty boards, and other stakeholders collaborated to develop educational milestones, observable steps in residents' professional development that describe progress from entry to graduation and beyond.

Objectives

We summarize the development of the milestones, focusing on 7 specialties, moving to the next accreditation system in July 2013, and offer evidence of their validity.

Methods

Specialty workgroups with broad representation used a 5-level developmental framework and incorporated information from literature reviews, specialty curricula, dialogue with constituents, and pilot testing.

Results

The workgroups produced richly diverse sets of milestones that reflect the community's consideration of attributes of competence relevant to practice in the given specialty. Both their development process and the milestones themselves establish a validity argument, when contemporary views of validity for complex performance assessment are used.

Conclusions

Initial evidence for validity emerges from the development processes and the resulting milestones. Further advancing a validity argument will require research on the use of milestone data in resident assessment and program accreditation.
Subtest Scores From the In-Training Examination: An Evaluation Tool for an Obstetric-Anesthesia Rotation
Authors: Gaiser Robert
Published: July 2013

Objective

To evaluate resident performance in the obstetric-anesthesia rotation using resident portfolios and their In-Training Examination scores, which are provided by the American Board of Anesthesiology/American Society of Anesthesiologists.

Methods

We reviewed academic portfolios for second- and third-year anesthesiology residents at a single institution from 2006–2008 to examine United States Medical Licensing Exam Step 1 and 2 scores, grade for obstetrics-gynecology in medical school, and performance on the In-Training Examination. Faculty evaluation of medical knowledge and correlations for the various scores were obtained.

Results

We examined scores for 43 residents. The subtest score for obstetric anesthesia increased after completing a rotation in obstetric anesthesia, 26.1 ± 10.3 versus 36.3 ± 10.6 (P  =  .02). The subtest score correlated with United States Medical Licensing Exam Step 2, r  =  0.46 (P  =  .027) but not with United States Medical Licensing Exam Step 1 or with the grade obtained in medical school. There was no correlation between faculty evaluations of medical knowledge and resident subtest scores in obstetric anesthesia.

Conclusions

Subtest scores in obstetric anesthesia are valid and provide a tool for the assessment of the educational program of a rotation. Knowledge as assessed by a faculty member is different from the knowledge assessed on a written examination. Both methods can help provide a more complete assessment of the resident and the rotation.
Residents as Role Models: The Effect of the Obstetrics and Gynecology Clerkship on Medical Students' Career Interest
Authors: Chang Judy C. , Odrobina Michele R. , McIntyre-Seltman Kathleen
Published: July 2013

Background

Medical students' choice of residency specialty is based in part on their clerkship experience. Postclerkship interest in a particular specialty is associated with the students' choice to pursue a career in that field. But, many medical students have a poor perception of their obstetrics and gynecology clerkships.

Objective

To determine whether fourth-year medical students' perceptions of teaching quality and quantity and amount of experiential learning during the obstetrics-gynecology clerkship helped determine their interest in obstetrics-gynecology as a career choice.

Methods

We distributed an anonymous, self-administered survey to all third-year medical students rotating through their required obstetrics and gynecology clerkship from November 2006 to May 2007. We performed bivariate analysis and used χ2 analysis to explore factors associated with general interest in obstetrics and gynecology and interest in pursuing obstetrics and gynecology as a career.

Results

Eighty-one students (N  =  91, 89% response rate) participated. Postclerkship career interest in obstetrics and gynecology was associated with perceptions that the residents behaved professionally (P < .0001) and that the students were treated as part of a team (P  =  .008). Having clear expectations on labor and delivery procedures (P  =  .014) was associated with postclerkship career interest. Specific hands-on experiences were not statistically associated with postclerkship career interest. However, performing more speculum examinations in the operating room trended toward having some influence (P  =  .068). Although more women than men were interested in obstetrics and gynecology as a career both before (P  =  .027) and after (P  =  .014) the clerkship, men were more likely to increase their level of career interest during the clerkship (P  =  .024).

Conclusions

Clerkship factors associated with greater postclerkship interest include higher satisfaction with resident professional behavior and students' sense of inclusion in the clinical team. Obstetrics and gynecology programs need to emphasize to residents their role as educators and professional role models for medical students.
Who's My Doctor? First-Year Residents and Patient Care: Hospitalized Patients' Perception of Their “Main Physician”
Authors: Dalia Samir , Schiffman Fred J.
Published: July 2013

Background

Studies have shown that a large portion of patient satisfaction is related to physician care, especially when the patient can identify the role of the physician on the team. Because patients encounter multiple physicians in teaching hospitals, it is often difficult to determine who the patient feels is his or her main caregiver. Surveys evaluating resident physicians would help to improve patient satisfaction but are not currently implemented at most medical institutions.

Intervention

We created a survey to judge patient satisfaction and to determine who patients believe is their “main physician” on the teaching service.

Methods

Patients on a medical teaching service at The Miriam Hospital during 20 days in March 2008 were asked to complete the survey. A physician involved in the research project administered the surveys. Surveys included 3 questions that judged patient's perception and identification of their primary physician and 7 questions regarding patient satisfaction. Completed surveys were analyzed using averages.

Results

Of the 126 patients identified for participation, 102 (81%) completed the survey. Most patients identified the intern (first-year resident) as their main physician. Overall, more than 90% of patients expressed satisfaction with their main physician.

Conclusion

Most patients on the teaching service perceived the intern as their main physician and were satisfied with their physician's care. One likely reason is that interns spend the greatest amount of time with patients on the teaching service.
Defining the Roles of Advisors and Mentors in Postgraduate Medical Education: Faculty Perceptions, Roles, Responsibilities, and Resource Needs
Authors: Woods Suzanne K. , Burgess Leigh , Kaminetzky Catherine , McNeill Diana , Pinheiro Sandro , Heflin Mitchell T.
Published: July 2013

Background

Residency program directors rely on an informal network of faculty mentors to provide guidance for residents. Faced with increasingly sophisticated competency-based evaluation systems and scrutiny of patient safety and resident well-being in today's environment, residency programs need more structured mechanisms for mentoring.

Objective

To clarify the role of resident advisors and mentors so that residents receive the right combination of direction and oversight to ensure their successful transition to the next phase of their careers.

Methods

The Duke Internal Medicine Residency Program undertook a formal assessment of the roles, responsibilities, and resource needs of its key faculty through a focus group made up of key faculty. A follow-up focus group of residents and chief residents was held to validate the results of the faculty group assessment.

Results

The distinction between advising and mentoring was our important discovery and is supported by literature that identifies that mentors and advisors differ in multiple ways. A mentor is often selected to match resources and expertise with a resident's needs or professional interests. An advisor is assigned with a role to counsel and guide the resident through the residency processes, procedures, and key learning milestones.

Conclusion

The difference between the role of advisor and that of mentor is of critical importance and allowed for the evolution of faculty participants' role as resident advisors, including the formulation of expectations for advisors, and the creation of an advisor toolkit. Our modifiable toolkit can enhance the advising process for residents in many disciplines. We saw an improvement in resident satisfaction from 2006 to 2009.
Multisource Feedback in the Ambulatory Setting
Authors: Warm Eric J. , Schauer Daniel , Revis Brian , Boex James R.
Published: July 2013

Background

The Accreditation Council for Graduate Medical Education has mandated multisource feedback (MSF) in the ambulatory setting for internal medicine residents. Few published reports demonstrate actual MSF results for a residency class, and fewer still include clinical quality measures and knowledge-based testing performance in the data set.

Methods

Residents participating in a year-long group practice experience called the “long-block” received MSF that included self, peer, staff, attending physician, and patient evaluations, as well as concomitant clinical quality data and knowledge-based testing scores. Residents were given a rank for each data point compared with peers in the class, and these data were reviewed with the chief resident and program director over the course of the long-block.

Results

Multisource feedback identified residents who performed well on most measures compared with their peers (10%), residents who performed poorly on most measures compared with their peers (10%), and residents who performed well on some measures and poorly on others (80%). Each high-, intermediate-, and low-performing resident had a least one aspect of the MSF that was significantly lower than the other, and this served as the basis of formative feedback during the long-block.

Conclusion

Use of multi-source feedback in the ambulatory setting can identify high-, intermediate-, and low-performing residents and suggest specific formative feedback for each. More research needs to be done on the effect of such feedback, as well as the relationships between each of the components in the MSF data set.
Validation of an Online Assessment of Orthopedic Surgery Residents' Cognitive Skills and Preparedness for Carpal Tunnel Release Surgery
Authors: Shanedling Janet , Van Heest Ann , Rodriguez Michael , Putnam Matthew , Agel Julie
Published: July 2013

Background

Surgical competence requires both cognitive and technical skills. Relatively little is found in the literature regarding the value of Web-based assessments to measure surgery residents' mastery of the competencies.

Objective

To determine the validity and reliability of 2 online instruments for predicting the cognitive preparedness of residents for performing carpal tunnel release surgery.

Method

Twenty-eight orthopedic residents and 2 medical school students responded to an online measure of their perception of preparedness and to an online cognitive skills assessment prior to an objective structured assessment of technical skills, in which they performed carpal tunnel release surgery on cadaveric specimens and received a pass/fail assessment. The 2 online assessments were analyzed for their internal reliability, external correlation with the pass/fail decision, and construct validity.

Results

The internal consistency of the perception of preparedness measure was high (α  =  .92) while the cognitive assessment was less strong (α  =  .65). Both instruments demonstrated moderately strong correlations with the pass/fail decision, with Spearman correlation of .606 (P  =  .000) and .617 (P  =  .000), respectively. Using logistic regression to analyze the predictive strength of each instrument, the perception of preparedness measure demonstrated a 76% probability (η2  =  .354) and the cognitive skills assessment a 73% probability (η2  =  .381) of correctly predicting the pass/fail decision. Analysis of variance modeling resulted in significant differences between levels at P < .005, supporting good construct validity.

Conclusions

The online perception of preparedness measure and the cognitive skills assessment both are valid and reliable predictors of readiness to successfully pass a cadaveric motor skills test of carpal tunnel release surgery.
Factors Impacting Hand Hygiene Compliance Among New Interns: Findings From a Mandatory Patient Safety Course
Authors: Gluck Paul A. , Nevo Igal , Lenchus Joshua D. , Sanko Jill S. , Everett-Thomas Ruth , Fitzpatrick Maureen , Shekhter Ilya , Arheart Kristopher L. , Birnbach David J.
Published: July 2013

Background

Residency is a critical transition during which individuals acquire lifelong behaviors important for professionalism and optimal patient care. One behavior is proper hand hygiene (HH), yet poor compliance with accepted HH practices remains a critical issue in many settings. This study explored the factors affecting hand hygiene compliance (HHC) in a diverse group of interns at the beginning of graduate training.

Methods

During a required patient safety course, we observed HH behaviors using a standardized patient encounter. Interns were instructed to perform a focused exam in a simulated inpatient environment with HH products available and clearly visible. Participants were blinded to the HH component of the study. An auditory alert was triggered if participants failed to perform prepatient encounter HH. Compliance rates and the number of alerts were recorded. All encounters were videotaped.

Results

The HHC among the 169 participants was 37.9% pre-encounter and was higher among female interns than males, although this difference was not statistically significant (41.6% versus 31.5%, P  =  .176). International medical graduates had significantly lower HHC compared with US graduates (23.2% versus 45.1%, P  =  .006). Most initially noncompliant participants performed HH after 1 alert (87.6%).

Discussion

The initial low rate of HHC in our sample is comparable to other studies. Using direct video surveillance and auditory alarms, we improved our success rates for prepatient encounter HHC. Our study identified medical school origin as an important factor for HHC, and the significantly lower compliance for international medical graduates compared with US graduates has not been previously reported. These findings should be considered in designing interventions such as intern orientation and clinical education programs to improve HH behaviors.
A Reliable Billing Method for Internal Medicine Resident Clinics: Financial Implications for an Academic Medical Center
Authors: Kapa Suraj , Beckman Thomas J. , Cha Stephen S. , Meyer Joyce A. , Robinet Charlotte A. , Bucher Diane K. , Hardy Jeanne M. , McDonald Furman S.
Published: July 2013

Background

The financial success of academic medical centers depends largely on appropriate billing for resident-patient encounters. Objectives of this study were to develop an instrument for billing in internal medicine resident clinics, to compare billing practices among junior versus senior residents, and to estimate financial losses from inappropriate resident billing.

Methods

For this analysis, we randomly selected 100 patient visit notes from a resident outpatient practice. Three coding specialists used an instrument structured on Medicare billing standards to determine appropriate codes, and interrater reliability was assessed. Billing codes were converted to US dollars based on the national Medicare reimbursement list. Inappropriate billing, based on comparisons with coding specialists, was then determined for residents across years of training.

Results

Interrater reliability of Current Procedural Terminology components was excellent, with κ ranging from 0.76 for examination to 0.94 for diagnosis. Of the encounters in the study, 55% were underbilled by an average of $45.26 per encounter, and 18% were overbilled by an average of $51.29 per encounter. The percentages of appropriately coded notes were 16.1% for postgraduate year (PGY) 1, 26.8% for PGY-2, and 39.3% for PGY-3 residents (P < .05). Underbilling was 74.2% for PGY-1, 48.8% for PGY-2, and 42.9% for PGY-3 residents (P < .01). There was significantly less overbilling among PGY-1 residents compared with PGY-2 and PGY-3 residents (9.7% versus 24.4% and 17.9%, respectively; P < .05).

Conclusions

Our study reports a reliable method for assessing billing in internal medicine resident clinics. It exposed large financial losses, which were attributable to junior residents more than senior residents. The findings highlight the need for educational interventions to improve resident coding and billing.
Enhancing Competency in Professionalism: Targeting Resident Advance Directive Education
Authors: Colbert Colleen Y. , Mirkes Curtis , Ogden Paul E. , Herring Mary Elizabeth , Cable Christian , Myers John D. , Ownby Allison R. , Boisaubin Eugene , Murguia Ida , Farnie Mark A. , Sadoski Mark
Published: July 2013

Background

Education about advance directives typically is incorporated into medical school curricula and is not commonly offered in residency. Residents' experiences with advance directives are generally random, nonstandardized, and difficult to assess. In 2008, an advance directive curriculum was developed by the Scott & White/Texas A&M University System Health Science Center College of Medicine (S&W/Texas A&M) internal medicine residency program and the hospital's legal department. A pilot study examining residents' attitudes and experiences regarding advance directives was carried out at 2 medical schools.

Methods

In 2009, 59 internal medicine and family medicine residents (postgraduate year 2–3 [PGY-2, 3]) completed questionnaires at S&W/Texas A&M (n  =  32) and The University of Texas Medical School at Houston (n  =  27) during a validation study of knowledge about advance directives. The questionnaire contained Likert-response items assessing attitudes and practices surrounding advance directives. Our analysis included descriptive statistics and analysis of variance (ANOVA) to compare responses across categories.

Results

While 53% of residents agreed/strongly agreed they had “sufficient knowledge of advance directives, given my years of training,” 47% disagreed/strongly disagreed with that statement. Most (93%) agreed/strongly agreed that “didactic sessions on advance directives should be offered by my hospital, residency program, or medical school.” A test of responses across residency years with ANOVA showed a significant difference between ratings by PGY-2 and PGY-3 residents on 3 items: “Advance directives should only be discussed with patients over 60,” “I have sufficient knowledge of advance directives, given my years of training,” and “I believe my experience with advance directives is adequate for the situations I routinely encounter.”

Conclusion

Our study highlighted the continuing need for advance directive resident curricula. Medical school curricula alone do not appear to be sufficient for residents' needs in this area.
Evaluating Practice-Based Learning and Improvement: Efforts to Improve Acceptance of Portfolios
Authors: Fragneto Regina Y. , DiLorenzo Amy Noel , Schell Randall M. , Bowe Edwin A.
Published: July 2013

Introduction

The Accreditation Council for Graduate Medical Education (ACGME) recommends resident portfolios as 1 method for assessing competence in practice-based learning and improvement. In July 2005, when anesthesiology residents in our department were required to start a portfolio, the residents and their faculty advisors did not readily accept this new requirement. Intensive education efforts addressing the goals and importance of portfolios were undertaken. We hypothesized that these educational efforts improved acceptance of the portfolio and retrospectively audited the portfolio evaluation forms completed by faculty advisors.

Methods

Intensive education about the goals and importance of portfolios began in January 2006, including presentations at departmental conferences and one-on-one education sessions. Faculty advisors were instructed to evaluate each resident's portfolio and complete a review form. We retrospectively collected data to determine the percentage of review forms completed by faculty. The portfolio reviews also assessed the percentage of 10 required portfolio components residents had completed.

Results

Portfolio review forms were completed by faculty advisors for 13% (5/38) of residents during the first advisor-advisee meeting in December 2005. Initiation of intensive education efforts significantly improved compliance, with review forms completed for 68% (26/38) of residents in May 2006 (P < .0001) and 95% (36/38) in December 2006 (P < .0001). Residents also significantly improved the completeness of portfolios between May and December of 2006.

Discussion

Portfolios are considered a best methods technique by the ACGME for evaluation of practice-based learning and improvment. We have found that intensive education about the goals and importance of portfolios can enhance acceptance of this evaluation tool, resulting in improved compliance in completion and evaluation of portfolios.
Revisiting Social Network Utilization by Physicians-in-Training
Authors: Black Erik W. , Thompson Lindsay A. , Duff W. Patrick , Dawson Kara , Saliba Heidi , Black Nicole M. Paradise
Published: July 2013

Objective

To measure and compare the frequency and content of online social networking among 2 cohorts of medical students and residents (2007 and 2009).

Methods

Using the online social networking application Facebook, we evaluated social networking profiles for 2 cohorts of medical students (n  =  528) and residents (n  =  712) at the University of Florida in Gainesville. Objective measures included existence of a profile, whether it was made private, and whether any personally identifiable information was included. Subjective outcomes included photographic content, affiliated social groups, and personal information not generally disclosed in a doctor-patient encounter. We compared our results to our previously published and reported data from 2007.

Results

Social networking continues to be common amongst physicians-in-training, with 39.8% of residents and 69.5% of medical students maintaining Facebook accounts. Residents' participation significantly increased (P < .01) when compared to the 2007 data. Individuals in the 2009 cohort had significantly more “friends” (P < .01), belonged to more “groups” (P < .01), and were more likely to limit public access to their profiles through the use of privacy settings (P < .01) than the individuals in the 2007 cohort.

Discussion

Online social networking application use by physicians-in-training remains common. While most now limit access to their profiles, personal profiles that still allow public access exhibited a few instances of unprofessional behavior. Concerns remain related to the discovery of content in violation of patient privacy and the expansive and impersonal networks of online “friends” who may view profiles.
Relationship Express: A Pilot Program to Teach Anesthesiology Residents Communication Skills
Authors: Berger Jeffrey S. , Blatt Benjamin , McGrath Brian , Greenberg Larrie , Berrigan Michael J.
Published: July 2013

Background

The Accreditation Council for Graduate Medical Education requires residency programs to teach 6 core competencies and to provide evidence of effective standardized training through objective measures. George Washington University's Department of Anesthesiology and Critical Care Medicine implemented a pilot program to address the interpersonal and communication skill competency. In this program, we aimed to pilot the Relationship Express model, a series of exercises in experiential learning to teach anesthesiology residents to build effective relationships with patients in time-limited circumstances. The purpose of this paper is to describe the application of this model for anesthesiology training.

Methods

A total of 7 first-year clinical anesthesiology residents participated in this pilot study, and 4 residents completed the entire program for analysis purposes. Relationship Express was presented in three 1.5-hour sessions: (1) introduction followed by 2-case, standardized patient pretest with feedback to residents from faculty observers; (2) interpersonal and communication skills didactic workshop with video behavior modeling; and (3) review discussion followed by 2-case, standardized patient posttest and evaluation.

Results

Modified Brookfield comments revealed the following themes: (1) time constraints were realistic compared with clinical practice; (2) admitting errors with patients was difficult; (3) patients were more aware of body language than anticipated; (4) residents liked the group discussions and the video interview; (5) standardized patients were convincing; and (6) residents found the feedback from faculty and standardized patients helpful.

Conclusions

Resident retrospective self-assessment and learning comments confirm the potential value of the Relationship Express model. This program will require further assessment and refinement with a larger number of residents.
Key Elements of Clinical Physician Leadership at an Academic Medical Center
Authors: Dine C. Jessica , Kahn Jeremy M , Abella Benjamin S , Asch David A , Shea Judy A
Published: July 2013

Background

A considerable body of literature in the management sciences has defined leadership and how leadership skills can be attained. There is considerably less literature about leadership within medical settings. Physicians-in-training are frequently placed in leadership positions ranging from running a clinical team or overseeing a resuscitation effort. However, physicians-in-training rarely receive such training. The objective of this study was to discover characteristics associated with effective physician leadership at an academic medical center for future development of such training.

Methods

We conducted focus groups with medical professionals (attending physicians, residents, and nurses) at an academic medical center. The focus group discussion script was designed to elicit participants' perceptions of qualities necessary for physician leadership. The lead question asked participants to imagine a scenario in which they either acted as or observed a physician leader. Two independent reviewers reviewed transcripts to identify key domains of physician leadership.

Results

Although the context was not specified, the focus group participants discussed leadership in the context of a clinical team. They identified 4 important themes: management of the team, establishing a vision, communication, and personal attributes.

Conclusions

Physician leadership exists in clinical settings. This study highlights the elements essential to that leadership. Understanding the physician attributes and behaviors that result in effective leadership and teamwork can lay the groundwork for more formal leadership education for physicians-in-training.
Educating Physicians-in-Training About Resource Utilization and Their Own Outcomes of Care in the Inpatient Setting
Authors: Dine C. Jessica , Miller Jean , Fuld Alexander , Bellini Lisa M. , Iwashyna Theodore J.
Published: July 2013

Background

Despite significant policy concerns about the role of inpatient resource utilization on rising medical costs, little information is provided to residents regarding their practice patterns and the effect on resource use. Improved knowledge about their practice patterns and costs might reduce resource utilization and better prepare physicians for today's health care market.

Methods

We surveyed residents in the internal medicine residency at the Hospital of the University of Pennsylvania. Based on needs identified via the survey, discussions with experts, and a literature review, a curriculum was created to help increase residents' knowledge about benchmarking their own practice patterns and using objective performance measures in the health care market.

Results

The response rate to our survey was 67%. Only 37% of residents reported receiving any feedback on their utilization of resources, and only 20% reported receiving feedback regularly. Even fewer (16%) developed, with their attending physician, a concrete improvement plan for resource use. A feedback program was developed that included automatic review of the electronic medical record to provide trainee-specific feedback on resource utilization and outcomes of care including number of laboratory tests per patient day, laboratory cost per patient day, computed tomography scan ordering rate, length of stay, and 14-day readmission rate. Results were benchmarked against those of peers on the same service. Objective feedback was provided biweekly by the attending physician, who also created an action plan with the residents. In addition, an integrated didactic curriculum was provided to all trainees on the hospitalist service on a biweekly basis.

Conclusions

Interns and residents do not routinely receive feedback on their resource utilization or ways to improve efficiency. A method for providing objective data on individual resource utilization in combination with a structured curriculum can be implemented to help improve resident knowledge and practice. Ongoing work will test the impact on resource utilization and outcomes.
Automated Data Mining: An Innovative and Efficient Web-Based Approach to Maintaining Resident Case Logs
Authors: Bhattacharya Pratik , Van Stavern Renee , Madhavan Ramesh
Published: July 2013

Background

Use of resident case logs has been considered by the Residency Review Committee for Neurology of the Accreditation Council for Graduate Medical Education (ACGME).

Objective

This study explores the effectiveness of a data-mining program for creating resident logs and compares the results to a manual data-entry system. Other potential applications of data mining to enhancing resident education are also explored.

Design/Methods

Patient notes dictated by residents were extracted from the Hospital Information System and analyzed using an unstructured mining program. History, examination and ICD codes were obtained and compared to the existing manual log. The automated data History, examination, and ICD codes were gathered for a 30-day period and compared to manual case logs.

Results

The automated method extracted all resident dictations with the dates of encounter and transcription. The automated data-miner processed information from all 19 residents, while only 4 residents logged manually. The manual method identified only broad categories of diseases; the major categories were stroke or vascular disorder 53 (27.6%), epilepsy 28 (14.7%), and pain syndromes 26 (13.5%). In the automated method, epilepsy 114 (21.1%), cerebral atherosclerosis 114 (21.1%), and headache 105 (19.4%) were the most frequent primary diagnoses, and headache 89 (16.5%), seizures 94 (17.4%), and low back pain 47 (9%) were the most common chief complaints. More detailed patient information such as tobacco use 227 (42%), alcohol use 205 (38%), and drug use 38 (7%) were extracted by the data-mining method.

Conclusions

Manual case logs are time-consuming, provide limited information, and may be unpopular with residents. Data mining is a time-effective tool that may aid in the assessment of resident experience or the ACGME core competencies or in resident clinical research. More study of this method in larger numbers of residency programs is needed.
Postgraduate Year-1 Residency Training in Emergency Psychiatry: An Acute Care Psychiatric Clinic at a Community Mental Health Center
Authors: Bennett Jeffrey I. , Costin George , Khan Mehnaz , Mazhar Mir Nadeem , Dzara Kristina , Conklen Mary , Hannig Jo Ann
Published: July 2013

Objective

The purpose of this study was to determine resident satisfaction with an acute care psychiatric clinic designed in collaboration with a nearby community mental health center. We also sought to demonstrate that this rotation helps meet program requirements for emergency psychiatry training, provides direct assessments of resident interviewing skills and clinical knowledge in the postgraduate year-1, and provides exposure to public sector systems of care.

Methods

We developed a resident satisfaction questionnaire and fielded it to each of the residents who participated in the clinic over the first 3 years. Data were collected, organized, and analyzed.

Results

Of the 15 residents in the acute care psychiatric clinic, 12 completed and returned the satisfaction questionnaires. Educational aspects of the clinic experience were rated favorably.

Conclusions

This postgraduate year-1 acute care psychiatric clinic provides a mechanism for the fulfillment of emergency psychiatry training as well as direct supervision of clinical encounters, which is a satisfactory and useful educational experience for trainees.
Quality of Cardiovascular Care in an Internal Medicine Resident Clinic
Authors: Masterson Eileen , Patel Priyanka , Kuo Yen-Hong , Francis Charles K.
Published: July 2013

Background

Attainment of treatment goals derived from evidence-based practice guidelines can be a useful measure of the quality of cardiovascular care. To date, there are few studies of the quality of care provided in a resident continuity clinic, as measured by success in meeting nationally defined guidelines for control of cardiovascular risk factors. There also is limited information regarding the quality of care in resident continuity clinics serving multiethnic uninsured/underinsured populations. This study assessed the efficacy of residents in internal medicine in attaining evidence-based, guideline-defined treatment goals for control of hypertension, dyslipidemia, and hyperglycemia in an uninsured/underinsured multiethnic population.

Methods

In a cross-sectional study of patients treated exclusively by residents (with faculty supervision) between July 1 and December 31, 2005, data were abstracted from the medical records of 628 consecutive patients (mean age, 55.6 years; 62% female; 61.3% non-white; 55.5% uninsured) with hypertension, hyperlipidemia, and/or diabetes mellitus. Quality measures were the proportion of diabetic and nondiabetic patients who met guideline-defined treatment goals for hypertension, dyslipidemia, and hyperglycemia in diabetic patients.

Results

Goal attainment overall was 44.9% for high blood pressure, 55.7% for dyslipidemia, and 43.3% for hemoglobin A1c for diabetic patients. There was no relationship between age, gender, race/ethnicity, insurance, or body weight to attainment of hypertension, dyslipidemia, or hemoglobin A1c goals in diabetic and nondiabetic cohorts from multivariate analysis. Risk factor control rates were higher in this study than in comparable educational programs.

Conclusion

An internal medicine resident continuity clinic can provide high-quality care that meets guideline-defined cardiovascular risk factor control goals in a racially and ethnically diverse, underinsured/uninsured, low-income population in a community-based academic medical center.
Residents' Self-Perceived Errors in Transitions of Care in the Emergency Department
Authors: Smith Dustin , Burris J. Wayne , Mahmoud Guisou , Guldner Gregory
Published: July 2013

Background

The Accreditation Council for Graduate Medical Education requirements for systems-based practice state residents are expected to participate in identifying system errors and implementing potential systems solutions. The objective of this study was to determine the numbers of perceived errors occurring from patient pass offs between resident physicians in our emergency department.

Methods

Using a prospective observational study, we queried emergency medicine residents about perceived errors in the transition of care using trained research assistants and a standardized protocol. Transition of care was defined as the transfer of responsibility to evaluate and treat and disposition of a patient in the emergency department from 1 resident physician to a second oncoming emergency department resident physician. Mean resident-perceived errors per shift and per patient transfer of care were calculated. Additionally, the mean number of perceived errors impacting patients was calculated.

Results

Emergency medicine residents on 107 shifts reported receiving 713 patients in pass off with a mean of 7 patients per physician per shift, with 40% of patients passed off needing some intervention (mean of 2.8 patients per provider per shift). Nineteen of the 107 shifts (17.8%) during which a resident took patients from a prior provider had a perceived error in at least 1 patient signed off. Of the 713 patients transitioned, the receiving physician perceived an error related to the transition of care for 23. Two of the 23 errors were determined by reviewing emergency medicine attendings to not be errors, and for 9 the receiving physician perceived an impact on the patient. All were delays in care or disposition.

Conclusion

Our data suggest emergency medicine residents were able to perceive errors related to transitions of care, describe the types of pass-off errors, and, to a lesser degree, describe the impact these errors have on patients.
Direct Versus Indirect Supervision of Fellows Covering Football Events: A Survey of Fellows and Program Directors
Authors: Lascano Charles A. , Stovak Mark L. , Harvey A. T.
Published: July 2013

Background

The Accreditation Council for Graduate Medical Education (ACGME) program requirements mandate “adequate supervision,” of residents, but there is little guidance for sports medicine fellowship directors regarding the transition from direct to indirect supervision of fellows covering football games.

Objective

We sought to gather evidence of current supervision practices in the context of injury outcomes.

Methods

Fellows and program directors of ACGME-accredited sports medicine fellowship programs were invited to complete an online survey regarding their experience and current supervision practice at football games. Criteria for transition to autonomy and desired changes in supervision practice were elicited. Player safety was quantified by noting the number of field-side emergencies, whether an attending was present, and whether better outcomes might have resulted from the presence of an attending.

Results

A total of 80 fellows and 50 program directors completed the online survey. Direct supervision was lacking in about 50% of high school games and 20% of college games. A resulting cost in terms of player safety was estimated to apply to 5% of serious injuries by fellows' report but less than 0.5% by directors' report. Written criteria for transitioning from direct supervision to autonomy were the exception rather than the rule. The majority of fellows and directors expressed satisfaction with the current level of supervision, but 20% of fellows would prefer more supervision through postgame review.

Conclusions

Football games covered by fellows are often not directly supervised. Absence of an attending affected the outcomes of 5% or less of serious injuries. Transition to autonomy does not usually require meeting written criteria. Fellows might benefit from additional off-site supervision.
Two Perspectives on the Educational and Administrative Roles of the Pediatric Chief Resident
Authors: Dabrow Sharon M , Harris Elizabeth J , Maldonado Luis A , Gereige Rani S
Published: July 2013

Purpose

To investigate pediatric chief residents' responsibilities and determine how chief residents and program directors view the scope of the chief resident's role.

Survey

We distributed a 20-item survey to program directors and chief residents at all US pediatric residency programs. Questions pertained to activities performed and the level of importance of administrative, clinical, and educational activities. The survey also investigated motivating factors to become chief resident, future career plans, and level of job satisfaction.

Results

We received responses from 127 program directors and 101 chief residents. Of the chief residents, 98% (99/101) felt administrative tasks were very/somewhat important, followed by education, service, and research. Significantly more program directors than chief residents felt chiefs' overall workload was well balanced. Program directors gave higher ratings than chief residents on chief's ability to develop clinical skills (79% [95/121] versus 61% [61/100]) and manage stress and burnout (86% [104/121] versus 72% [72/100]). Future career plans for chief residents in decreasing order included fellowship, outpatient practice, academic practice, and working as a hospitalist. The most significant problems reported by the chief residents were lack of administrative support and lack of time spent in educational/clinical activities.

Conclusions

The chief resident role is primarily administrative, but program directors and chiefs feel teaching and clinical responsibilities also are important. Although the 2 groups agreed in many areas, program directors underestimated the administrative demands placed on the chief residents, and our findings suggest the chief resident role may be more fulfilling if the balance was shifted somewhat toward teaching and clinical responsibilities.
Potentially Discriminatory Questions During Residency Interviews: Frequency and Effects on Residents' Ranking of Programs in the National Resident Matching Program
Authors: Santen Sally A. , Davis Kevin R. , Brady Donald W. , Hemphill Robin R.
Published: July 2013

Background

Medical students rank residency programs as part of the selection process in the National Resident Matching Program, also known as the match. Applicants to medical residency positions are protected against discriminatory employment practices by federal employment laws.

Objectives

To explore students' recall of being asked potentially illegal or discriminatory questions during the selection interview, and whether these questions affected students' ranking of the programs in the match.

Methods

Fourth-year medical students from a single medical school were surveyed after the match. Students were questioned about their recall of the frequency of potentially illegal or discriminatory interview questions and their effect on the program's rank.

Results

Ninety percent of the 63 respondents in the study remember being asked at least one potentially discriminatory question. Among these, students were asked about their marital status (86%), about children (31%), about plans for pregnancy (10%), where they were born (54%) and/or about their national origin (15%), and about religious and ethical beliefs (24%). The majority of students did not think the questions changed their decision to rank the program, although the questions changed the way some students ranked the program, either lowering or raising the rank.

Conclusion

Nearly all students reported that they were asked at least one potentially discriminatory question, although these questions for the most part do not appear to affect whether they ranked the programs.
Engaging Senior Residents as Leaders: A Novel Structure for Multiple Chief Roles
Authors: Biese Kevin , Leacock Benjamin W. , Osmond Christopher R. , Hobgood Cherri D.
Published: July 2013

Background

The chief resident's role encompasses administrative, academic, educational, and social responsibilities and is traditionally filled by a small number of residents who are charged with various administrative and educational duties. These duties lay the groundwork that prepares chief residents to assume future leadership positions.

Intervention

We propose a new model for multiple chief residents. In this system, there are leadership roles for resident and medical student education, ultrasonography, resident research, and high-fidelity simulation in addition to the traditional administrative roles. This model can be modified to match the needs of a given program and the aptitudes of the senior residents.

Results

We describe the successful implementation of this model at our program, which has resulted in a progressive curriculum, increased resident leadership, and program ownership among the residents.

Conclusions

Our intervention offers an alternative model for overcoming some of the limitations of the traditional chief resident model, including some chief residents who become overwhelmed by their duties and are discouraged from pursuing future leadership roles. It also has the potential to offer other senior residents with various skills and leadership abilities the opportunities to contribute to their program.
Evidence for Increasing Diversity in Graduate Medical Education: The Competence of Underrepresented Minority Residents Measured by an Intern Objective Structured Clinical Examination
Authors: Lypson Monica L. , Ross Paula T. , Hamstra Stanley J. , Haftel Hilary M. , Gruppen Larry D. , Colletti Lisa M.
Published: July 2013

Objective

Some have commented that the limited number of underrepresented minorities (URMs) in United States' residency programs is due to a lack of qualified candidates. At the University of Michigan, an objective structured clinical examination is administered to incoming residents at the beginning of training to determine baseline competence. In this study we wanted to determine if competence differed for underrepresented minorities when compared to non-URM residents.

Method

The postgraduate orientation assessment, a 10-station examination, was developed that focused specifically on the knowledge and skills needed in the first 6 to 18 weeks of training. Stations assessed competence in informed consent, aseptic technique, evidence-based medicine, diagnostic images, critical laboratory values, cross-cultural communication, and Joint Commission requirements such as surgical fire safety, pain assessment, and management. We used various assessment measures including standardized patients, computer-based testing, and multiple-choice questions.

Results

Our study found no significant differences in overall mean scores between URM residents and all other residents for the 5 years during which we administered the examination, except for 2002. This stands in contrast to the consistently worse performances of URM students on USMLE Step 1 and Step 2 Clinical Knowledge. Also, URM residents did not perform better or worse than their non-URM colleagues on standardized patient stations during the course of 5 years during which the examination was administered.

Conclusions

The postgraduate orientation assessment provides residency program directors with a standard format to measure initial clinical skills. When compared to incoming non-URM residents from a variety of medical schools, URM residents perform as well as other trainees. Our results may aid in the recruitment efforts of URM medical students into academic residency programs such as those at the University of Michigan.