bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and Preliminary Evaluation of a Practice-Based Learning and Improvement Tool for Assessing Resident Competence and Guiding Curriculum Development
Authors: Lawrence Renée H , Tomolo Anne M
Published: July 2013

Background

Although practice-based learning and improvement (PBLI) is now recognized as a fundamental and necessary skill set, we are still in need of tools that yield specific information about gaps in knowledge and application to help nurture the development of quality improvement (QI) skills in physicians in a proficient and proactive manner. We developed a questionnaire and coding system as an assessment tool to evaluate and provide feedback regarding PBLI self-efficacy, knowledge, and application skills for residency programs and related professional requirements.

Methods

Five nationally recognized QI experts/leaders reviewed and completed our questionnaire. Through an iterative process, a coding system based on identifying key variables needed for ideal responses was developed to score project proposals. The coding system comprised 14 variables related to the QI projects, and an additional 30 variables related to the core knowledge concepts related to PBLI. A total of 86 residents completed the questionnaire, and 2 raters coded their open-ended responses. Interrater reliability was assessed by percentage agreement and Cohen κ for individual variables and Lin concordance correlation for total scores for knowledge and application. Discriminative validity (t test to compare known groups) and coefficient of reproducibility as an indicator of construct validity (item difficulty hierarchy) were also assessed.

Results

Interrater reliability estimates were good (percentage of agreements, above 90%; κ, above 0.4 for most variables; concordances for total scores were R  =  .88 for knowledge and R  =  .98 for application).

Conclusion

Despite the residents' limited range of experiences in the group with prior PBLI exposure, our tool met our goal of differentiating between the 2 groups in our preliminary analyses. Correcting for chance agreement identified some variables that are potentially problematic. Although additional evaluation is needed, our tool may prove helpful and provide detailed information about trainees' progress and the curriculum.
Observational Study Using the Tools of Lean Six Sigma to Improve the Efficiency of the Resident Rounding Process
Authors: Chand David V.
Published: July 2013

Background

Recent focus on resident work hours has challenged residency programs to modify their curricula to meet established duty hour restrictions and fulfill their mission to develop the next generation of clinicians. Simultaneously, health care systems strive to deliver efficient, high-quality care to patients and families. The primary goal of this observational study was to use a data-driven approach to eliminate examples of waste and variation identified in resident rounding using Lean Six Sigma methodology. A secondary goal was to improve the efficiency of the rounding process, as measured by the reduction in nonvalue-added time.

Methods

We used the “DMAIC” methodology: define, measure, analyze, improve, and control. Pediatric and family medicine residents rotating on the pediatric hospitalist team participated in the observation phase. Residents, nurses, hospitalists, and parents of patients completed surveys to gauge their attitudes toward rounds. The Mann-Whitney test was used to test for differences in the median times measured during the preimprovement and postimprovement phases, and the Student t test was used for comparison of survey data.

Results and Discussion

Collaborative, family-centered rounding with elimination of the “prerounding” process, as well as standard work instructions and pacing the process to meet customer demand (takt time), were implemented. Nonvalue-added time per patient was reduced by 64% (P  =  .005). Survey data suggested that team members preferred the collaborative, family-centered approach to the traditional model of rounding.

Conclusions

Lean Six Sigma provides tools, a philosophy, and a structured, data-driven approach to address a problem. In our case this facilitated an effort to adhere to duty hour restrictions while promoting education and quality care. Such approaches will become increasingly useful as health care delivery and education continue to transform.
Interdisciplinary Prenatal Group Visits as a Significant Learning Experience
Authors: McLeod Angela Yerdon , LaClair Cynthia , Kenyon Tina
Published: July 2013

Aim

Group visits offer documented benefit to patients and clinicians. They also provide an excellent venue to teach residents interdisciplinary care and group facilitation skills.

Intervention

Third-year residents received experiential training to provide prenatal care through group visits rather than one-on-one visits.

Study Method

A descriptive study is used to illustrate the effectiveness of various facets of resident skill acquisition and patient-centered prenatal care. Evaluation methods included feedback from patients, team members, learner self-reflection, and observation by a behavioral health clinician.

Residents collaboratively provide prenatal care in a group model during a 6-month period. Interdisciplinary team members explicitly teach and model biopsychosocial whole-person care and effective communication. This inventive experience has increased resident competency-based skills in facilitation and effective team collaboration as measured through observation. These skills are directly applicable in future primary care medical home practice. Using a group visit model benefits patients and clinicians, and promotes enriching and effective resident education. Our model can easily be implemented in other programs.
A Public Health Approach to Pediatric Residency Education: Responding to Social Determinants of Health
Authors: Kuo Alice A. , Shetgiri Rashmi , Guerrero Alma D. , Barreto Patricia M. , Perez Victor H. , Fond Karen , Slusser Wendelin
Published: July 2013

Objective

To evaluate the impact of a public health approach to pediatric residency education on learner knowledge, skills, attitudes, beliefs, and career choice.

Background

Incorporating public health principles into traditional residency education can give pediatricians the population-oriented perspective to address social determinants of health.

Methods

The Community Health and Advocacy Training (CHAT) program is an educational intervention with a public health framework. From 2001–2007, 215 categorical pediatric residents and 37 residents in the CHAT program were evaluated by using an annual survey of community pediatrics exposure, knowledge, attitudes, and beliefs. American Board of Pediatrics (ABP) examination passage rates for both groups were also examined, as was career choice after graduation.

Results

While interns in both the categorical and CHAT programs scored similarly on attitudes, beliefs, skills, and knowledge of community pediatrics, the postgraduate level-3 (PL-3) year CHAT residents scored higher in attitudes (P < .001) and skills (P < .05). Exposure to both didactic (P < .05) and practical (P < .001) community pediatrics curricular experiences were higher for CHAT residents than for categorical residents. No significant differences between ABP examination scores were found for the 2 groups, although 100% of CHAT graduates passed on the first try compared to 91% of categorical graduates during this time period. A greater percentage of CHAT graduates (82%) than categorical graduates (53%) reported pursuing careers in primary care.

Conclusion

With a public health approach to residency education, residents gain the knowledge, attitudes, and skills to address child health problems from a population perspective. Participation in such a curriculum still resulted in high passage rates on the ABP examination.
Training Gaps for Pediatric Residents Planning a Career in Primary Care: A Qualitative and Quantitative Study
Authors: Rosenberg Adam A , Kamin Carol , Glicken Anita Duhl , Jones M. Douglas
Published: July 2013

Background

Resident training in pediatrics currently entails similar training for all residents in a fragmented curriculum with relatively little attention to the career plans of individual residents.

Objectives

To explore strengths and gaps in training for residents planning a career in primary care pediatrics and to present strategies for addressing the gaps.

Methods

Surveys were sent to all graduates of the University of Colorado Denver Pediatric Residency Program (2003–2006) 3 years after completion of training. Respondents were asked to evaluate aspects of their training, using a 5-point Likert scale and evaluating each item ranging from “not at all well prepared” to “extremely well prepared” for their future career. In addition, focus groups were conducted with practitioners in 8 pediatric practices in Colorado. Sessions were transcribed and hand coded by 2 independent coders.

Results

Survey data identified training in behavior and development (mean score, 3.72), quality improvement and patient safety strategies (mean, 3.57), and practice management (mean, 2.46) as the weakest aspects of training. Focus groups identified deficiencies in training in mental health, practice management, behavioral medicine, and orthopedics. Deficiencies noted in curriculum structure were lack of residents' long-term continuity of relationships with patients; the need for additional training in knowledge, skills, and attitudes needed for primary care (perhaps even a fourth year of training); and a training structure that facilitates greater resident autonomy to foster development of clinical capability and self-confidence.

Conclusions

Important gaps were identified in the primary care training of pediatric residents. These data support the need to develop more career-focused training.
Changing the Formula of Residents' Work Hours in Internal Medicine: Moving From “Years in Training” to “Hours in Training”
Authors: Mansi Ishak A
Published: July 2013

Background

In a recent report, the Institute of Medicine recommended more restrictions on residents' working hours. Several problems exist with a system that places a weekly limit on resident duty hours: (1) it assumes the presence of a linear relationship between hours of work and patient safety; (2) it fails to consider differences in intensity among programs; and (3) it does not address increases in the scientific content of medicine, and it places the burden of enforcing the duty hour limits on the Accreditation Council for Graduate Medical Education.

Proposal

An innovative method of calculating credit hours for graduate medical education would shift the focus from “years of residency” to “hours of residency.” For example, internal medicine residents would be requested to spend 8640 hours of total training hours (assuming 60 hours per week for 48 weeks annually) instead of the traditional 3 years. This method of counting training hours is used by other professions, such as the Intern Development Program of the National Council of Architectural Registration Boards. The proposed approach would allow residents and program directors to pace training based on individual capabilities. Standards for resident education should include the average number of patients treated in each setting (inpatient or outpatient). A possible set of “multipliers” based on these parameters, and possibly others such as resident evaluation, is devised to calculate the “final adjusted accredited hours” that count toward graduation.

Anticipated Benefits

Substituting “years of training” with “hours of training” may resolve many of the concerns with the current residency education model, as well as adapt to the demands of residents' personal lives. It also may allow residents to pace their training according to their capabilities and learning styles, and contribute to reflective learning and better quality education.
Competence in Patient Safety: A Multifaceted Experiential Educational Intervention for Resident Physicians
Authors: Lukela Michael P , Parekh Vikas I , Gosbee John W , Purkiss Joel A , Valle John Del , Mangrulkar Rajesh S
Published: July 2013

Background

The need to provide efficient, effective, and safe patient care is of paramount importance. However, most physicians receive little or no formal training to prepare them to address patient safety challenges within their clinical practice.

Methods

We describe a comprehensive Patient Safety Learning Program (PSLP) for internal medicine and medicine-pediatrics residents. The curriculum is designed to teach residents key concepts of patient safety and provided opportunities to apply these concepts in the “real” world in an effort to positively transform patient care. Residents were assigned to faculty expert-led teams and worked longitudinally to identify and address patient safety conditions and problems. The PSLP was assessed by using multiple methods.

Results

Resident team-based projects resulted in changes in several patient care processes, with the potential to improve clinical outcomes. However, faculty evaluations of residents were lower for the Patient Safety Improvement Project rotation than for other rotations. Comments on “unsatisfactory” evaluations noted lack of teamwork, project participation, and/or responsiveness to faculty communication. Participation in the PSLP did not change resident or faculty attitudes toward patient safety, as measured by a comprehensive survey, although there was a slight increase in comfort with discussing medical errors.

Conclusions

Development of the PSLP was intended to create a supportive environment to enhance resident education and involve residents in patient safety initiatives, but it produced lower faculty evaluations of resident for communication and professionalism and did not have the intended positive effect on resident or faculty attitudes about patient safety. Further research is needed to design or refine interventions that will develop more proactive resident learners and shift the culture to a focus on patient safety.
Use of Ecological Momentary Assessment to Guide Curricular Change in Graduate Medical Education
Authors: Willett Lisa L. , Estrada Carlos A. , Wall Terry C. , Coley Heather L. , Ngu Julius , Curry William , Salanitro Amanda , Houston Thomas K.
Published: July 2013

Purpose

To assess whether a novel evaluation tool could guide curricular change in an internal medicine residency program.

Method

The authors developed an 8-item Ecological Momentary Assessment tool and collected daily evaluations from residents of the relative educational value of 3 differing ambulatory morning report formats (scale: 8  =  best, 0  =  worst). From the evaluations, they made a targeted curricular change and used the tool to assess its impact.

Results

Residents completed 1388 evaluation cards for 223 sessions over 32 months, with a response rate of 75.3%. At baseline, there was a decline in perceived educational value with advancing postgraduate (PGY) year for the overall mean score (PGY-1, 7.4; PGY-2, 7.2; PGY-3, 7.0; P < .01) and for percentage reporting greater than 2 new things learned (PGY-1, 77%; PGY-2, 66%; PGY-3, 50%; P < .001). The authors replaced the format of a lower scoring session with one of higher cognitive content to target upper-level residents. The new session's mean score improved (7.1 to 7.4; P  =  .03); the adjusted odds ratios before and after the change for percentage answering, “Yes, definitely” to “Area I need to improve” was 2.53 (95% confidence interval [CI], 1.45–4.42; P  =  .001) and to “Would recommend to others,” it was 2.08 (95% CI, 1.12–3.89; P  =  .05).

Conclusions

The Ecological Momentary Assessment tool successfully guided ambulatory morning report curricular changes and confirmed successful curricular impact. Ecological Momentary Assessment concepts of multiple, frequent, timely evaluations can be successfully applied in residency curriculum redesign.
Addressing Core Competencies Through Hospital Quality Improvement Activities: Attitudes and Engagement
Authors: Lipstein Ellen A , Kronman Matthew P , Richmond Camilla , White Kristin Nyweide , Shugerman Richard P , McPhillips Heather A
Published: July 2013

Background

Hospital quality improvement initiatives are becoming increasingly common. Little is known about the influence of these initiatives on resident learning and attitudes. Our objective was to assess whether training in a hospital committed to involving residents in hospital-initiated, continuous quality improvement (CQI), and to participation in such activities, would influence residents' attitudes toward CQI and engagement in the hospital community.

Methods

We surveyed Seattle Children's Hospital pediatric residents, from residency graduation years 2002–2009. We included questions about participation in quality improvement activities during residency and measures of attitude toward CQI and of workplace engagement. We used descriptive statistics to assess trends in resident participation in hospital CQI activities, attitudes toward CQI and workplace engagement.

Results

The overall response rate was 84% (162 of 194). Among graduated residents, there was a significant trend toward increased participation in CQI activities (P  =  .03). We found no difference in attitude toward CQI between those who had and those who had not participated in such activities nor between residents who began training before and those who began after the hospital formally committed to CQI. Sixty-three percent of residents (25 of 40) who participated in CQI activities were engaged in the hospital community compared with 53% (57 of 107) who did not participate in CQI activities (P  =  .21).

Conclusions

Training in a hospital committed to involving residents in CQI was associated with a high rate of participation in CQI activities. Although such training and participation in CQI were not associated with resident attitudes toward CQI or hospital engagement, it may allow residents to learn skills for practice-based learning and improvement and systems-based practice.
Internal Medicine Physicians' Knowledge of Health Care Charges
Authors: Tek Sehgal Raj , Gorman Paul
Published: July 2013

Background

Concerns over the rising costs of health care have increased interest in educating residents about the cost impact of medical decisions. While many programs educate residents about the effectiveness of care, little is known about how well residents and faculty know charges of diagnostic tests or both groups' interest in this topic.

Methods

We surveyed internal medicine residents and faculty at an academic tertiary care hospital. Both groups rated their agreement with a series of statements about health care charges on a Likert scale of 1 (strongly disagree) to 9 (strongly agree), and they estimated the charges for 15 commonly ordered diagnostic tests. Estimates within 25% of the true charge were considered correct. The Wilcoxon rank sum test was used to compare responses between residents and faculty.

Results

Seventy of 126 eligible participants (56%) returned surveys. Participants showed poor knowledge of health care charges but expressed a desire to learn more. Physicians also felt that cost-effectiveness should be considered when ordering diagnostic tests, although faculty members felt more strongly about this than did residents. In estimating the charges for diagnostic tests, less than a quarter of all responses were within 25% of the true charge.

Conclusions

Internal medicine physicians poorly estimate the charges for diagnostic tests but have a strong desire to improve their knowledge, suggesting a possible intervention to improve the cost-effectiveness of medical care.
Learning Clinical Versus Leadership Competencies in the Emergency Department: Strategies, Challenges, and Supports of Emergency Medicine Residents
Authors: Goldman Ellen F , Plack Margaret M , Roche Colleen N , Smith Jeffrey P , Turley Catherine L
Published: July 2013

Background

Emergency medicine residents are expected to master 6 competencies that include clinical and leadership skills. To date, studies have focused primarily on teaching strategies, for example, what attending physicians should do to help residents learn. Residents' own contributions to the learning process remain largely unexplored. The purpose of this study was to explore what emergency medicine residents believe helps them learn the skills required for practice in the emergency department.

Methods

This qualitative study used semistructured interviews with emergency medicine residents at a major academic medical center. Twelve residents participated, and 11 additional residents formed a validation group. We used phenomenologic techniques to guide the data analysis and techniques such as triangulation and member checks to ensure the validity of the findings.

Results

We found major differences in the strategies residents used to learn clinical versus leadership skills. Clinical skill learning was approached with rigor and involved a large number of other physicians, while leadership skill learning was unplanned and largely relied on nursing personnel. In addition, with each type of skills, different aspects of the residents' personalities, motivation, and past nonclinical experiences supported or challenged their learning process.

Conclusion

The approaches to learning leadership skills are not well developed among emergency medicine residents and result in a narrow perspective on leadership. This may be because of the lack of formal leadership training in medical school and residency, or it may reflect assumptions regarding how leadership skills develop. Substantial opportunity exists for enhancing emergency medicine residents' learning of leadership skills as well as the teaching of these skills by the attending physicians and nurses who facilitate their learning.
Global Health Training During Residency: The Weill Cornell Tanzania Experience
Authors: Hau Duncan K , DiPace Jennifer I , Peck Robert N , Johnson Warren D
Published: July 2013

Background

In 2007, Weill Cornell Medical College (WCMC) began annually to send approximately 30 residents in internal medicine and pediatrics to Bugando Medical Center in Mwanza, Tanzania, where they were supervised and mentored by 2 full-time WCMC faculty physicians.

Objective

To describe the components of the WCMC global health elective and to evaluate the experiences of the participants.

Methods

Subjects were WCMC residents in internal medicine and pediatrics from the graduating classes of 2007–2009. Electronic surveys were sent to all participants (n  = 57) and to a group of nonparticipants (n  =  57).

Results

Overall response rate was 58%. The most-selected, primary reasons for participation in the program were an interest in global health and a desire to serve an underprivileged population. Participants rated use of routine laboratory tests in the United States as more overused than did nonparticipants (P  =  .01). After the elective, 62% of participants reported a reduced use of laboratory and/or radiologic tests. All participants (100%; 39 of 39) reported the elective as having a positive effect on their knowledge of international health and tropical medicine. More than 90% of participants (36 of 39) reported the elective as having a positive effect on their physical examination skills.

Conclusions

Participants of the WCMC global health elective report positive experiences from our multidimensional global health collaboration.
Educating Generalists: Factors of Resident Continuity Clinic Associated With Perceived Impact on Choosing a Generalist Career
Authors: Laponis Ryan , O'Sullivan Patricia S. , Hollander Harry , Cornett Patricia , Julian Katherine
Published: July 2013

Background

Fewer residents are choosing general internal medicine (GIM) careers, and their choice may be influenced by the continuity clinic experience during residency. We sought to explore the relationship between resident satisfaction with the continuity clinic experience and expressed interest in pursuing a GIM career.

Methods

We surveyed internal medicine residents by using the Veterans Health Administration Office of Academic Affiliations Learners' Perceptions Survey—a 76-item instrument with established reliability and validity that measures satisfaction with faculty interactions, and learning, working, clinical, and physical environments, and personal experience. We identified 15 reliable subscales within the survey and asked participants whether their experience would prompt them to consider future employment opportunities in GIM. We examined the association between satisfaction measures and future GIM interest with 1-way analyses of variance followed by Student-Newman-Keuls post hoc tests.

Results

Of 217 residents, 90 (41%) completed the survey. Residents felt continuity clinic influenced career choice, with 22% more likely to choose a GIM career and 43% less likely. Those more likely to choose a GIM career had higher satisfaction with the learning (P  =  .001) and clinical (P  =  .002) environments and personal experience (P < .001). They also had higher satisfaction with learning processes (P  =  .002), patient diversity (P < .001), coordination of care (P  =  .009), workflow (P  =  .001), professional/personal satisfaction (P < .001), and work/life balance (P < .001).

Conclusions

The continuity clinic experience may influence residents' GIM career choice. Residents who indicate they are more likely to pursue GIM based on that clinical experience have higher levels of satisfaction. Further prospective data are needed to assess if changes in continuity clinic toward these particular factors can enhance career choice.
Neonatal Resuscitation Skills Among Pediatricians and Family Physicians: Is Residency Training Preparing for Postresidency Practice?
Authors: Wood Amy M. , Jones M. Douglas , Wood James H. , Pan Zhaoxing , Parker Thomas A.
Published: July 2013

Background

Pediatricians and family physicians are responsible for providing newborn resuscitation, yet Accreditation Council for Graduate Medical Education requirements for training in this area during residency differ markedly for the two specialties. Our objectives were to determine (1) the extent to which neonatal resuscitation training differs for pediatric and family medicine residents; (2) the extent to which general pediatricians and family physicians engage in newborn resuscitation in their practice; and (3) whether use of resuscitation skills differs between urban/suburban and rural providers.

Methods

We surveyed a national cohort of pediatricians and family physicians who obtained board certification between 2001 and 2005. Data were analyzed based on type of physician and setting of current practice.

Results

Survey response rate was 22% (382 of 1736). Compared with family medicine physicians, pediatricians received more neonatal resuscitation training during residency. Most members of both groups had attended no deliveries in the year prior to the survey (75% [111 of 148] versus 74% [114 of 154]). In their current practice, the groups were equally likely to have provided a newborn bag and mask ventilation, chest compressions, and resuscitation medications. Pediatricians were more likely than family physicians to have attempted to either intubate a newborn (20% [28 of 148] versus 10% [16 of 153]; P  =  .0495) or insert umbilical catheters (15% [22 of 148] versus 5% [8 of 153]; P  =  .005). Regardless of specialty, rural physicians were much more likely to report that they attended deliveries (61% [41 of 67] versus 15% [36 of 234]; P < .001). Among rural pediatricians attending deliveries, 44% (7 of 16) reported feeling inadequately prepared for at least one delivery in the past year.

Conclusions

Few primary care pediatricians and family physicians provide newborn resuscitation after residency. For those who do attend deliveries, current training may provide insufficient preparation. Flexible, individualized residency curricula could target intensive resuscitation training to individuals who plan to practice in rural areas and/or attend deliveries after graduation.
The Utility of Letters of Recommendation in Predicting Resident Success: Can the ACGME Competencies Help?
Authors: Stohl Hindi E , Hueppchen Nancy A , Bienstock Jessica L
Published: July 2013

Background

The Accreditation Council for Graduate Medical Education (ACGME) core competencies are used to assess resident performance, and recently similar competencies have become an accepted framework for evaluating medical student achievements as well. However, the utility of incorporating the competencies into the resident application has not yet been assessed.

Purpose

The objective of this study was to examine letters of recommendation (LORs) to identify ACGME competency–based themes that might help distinguish the least successful from the most successful residents.

Methods

Residents entering a university-based residency program from 1994 to 2004 were retrospectively evaluated by faculty and ranked in 4 groups according to perceived level of success. Applications from residents in the highest and lowest groups were abstracted. LORs were qualitatively reviewed and analyzed for 9 themes (6 ACGME core competencies and 3 additional performance measures). The mean number of times each theme was mentioned was calculated for each student. Groups were compared using the χ2 test and the Student t test.

Results

Seventy-five residents were eligible for analysis, and 29 residents were ranked in the highest and lowest groups. Baseline demographics and number of LORs did not differ between the two groups. Successful residents had statistically significantly more comments about excellence in the competency areas of patient care, medical knowledge, and interpersonal and communication skills.

Conclusion

LORs can provide useful clues to differentiate between students who are likely to become the least versus the most successful residency program graduates. Greater usage of the ACGME core competencies within LORs may be beneficial.
The Effect of Bedside Presentations in the Emergency Department on Patient Satisfaction
Authors: Schranz Craig I. , Sobehart Robert J. , Fallgatter Kiva , Riffenburgh Robert H. , Matteucci Michael J.
Published: July 2013

Background

Due to increasing time constraints, the use of bedside presentations in resident education has declined. We examined whether patient satisfaction in the emergency department is affected when first-year residents present at the bedside with attendings.

Methods

We performed an observational, prospective, nonblinded study in the emergency department of a military teaching hospital. We alternately assigned first-year residents to present a convenience sample of 248 patients to the attending physician at the patient's bedside or away from the patient. We measured patient satisfaction by using the Patient Satisfaction Questionaire-18 (PSQ-18), a validated survey instrument that utilizes a Likert scale, and additional nonvalidated survey questions involving Likert and visual analog scales.

Results

While the median PSQ-18 score of 74 (95% confidence interval [CI], 72–76) was higher for patient satisfaction when residents made bedside presentations than that for standard presentations, 72 (95% CI, 70–74), the difference did not reach statistical significance (P  =  .33).

Conclusion

There was no significant difference in overall patient satisfaction between residents' bedside presentations and presentations to attendings away from the patient. Although not significant, the differences noted in PSQ-18 subscales of communication, general satisfaction, and interpersonal manner warrant further investigation. Patients did not appear to be uncomfortable with having their care discussed and with having subsequent resident education at the bedside. Future research on patient satisfaction after implementation of standardized bedside teaching techniques may help further elucidate this relationship.
Training Residents to Address Cancer Health Disparities
Authors: Taylor Beverly D. , Buckner Ayanna V. , Walker Carla Durham , Azonobi Ijeoma
Published: July 2013

Introduction

Cancer is the source of significant morbidity and mortality in the United States, and eliminating cancer-related racial and ethnic disparities has become an ever-increasing focus of public health efforts. Increasing workforce diversity plays a major role in the reduction of health disparities, and a well-trained professional workforce is essential for the prevention, control, and ultimate elimination of this disease.

Methods

To help address this need, the Public Health/General Preventive Medicine residency program at Morehouse School of Medicine (MSM) developed an innovative Cancer Prevention and Control Track (CPCT). We describe the structure of the track, funding, examples of resident activities, and program successes.

Results

Since the development of the track in 2007, there have been 3 graduates, and 2 residents are currently enrolled. Residents have conducted research projects and have engaged in longitudinal community-based activities, cancer-focused academic experiences, and practicum rotations. There have been 3 presentations at national meetings, 1 research grant submitted, and 1 research award.

Conclusion

The CPCT provides residents with comprehensive cancer prevention and control training with emphasis in community engagement, service, and research. It builds on the strengths of the diversity training already offered at MSM and combines resources from academia, the private sector, and the community at large.
Giving Feedback on Clinical Skills: Are We Starving Our Young?
Authors: Anderson Peter A. M.
Published: July 2013

Background

Feedback to clinical learners about their performance is crucial to their development into competent clinicians. Most feedback is provided by clinicians who have little or no formal training for this aspect of their teaching role.

Method

Narrative review.

Findings

Feedback is most effective if provided by clinical mentors based on observations of behavior, with emphasis on correctable deficiencies. The difference between feedback, which is formative, and evaluation, which is summative, needs to be understood by both the giver and receiver. The ability to self-assess is an important related concept, with studies showing that self-assessment skills are lowest in individuals found to be the least competent in external assessments and in individuals with a high level of confidence.

Conclusions

Feedback is an important component in learners' development, and clinical faculty should be educated about the importance of providing feedback, and the means to do so effectively must be provided to them. Despite several decades of accumulated knowledge in this area, the evidence from learners is that we continue to starve them of this critical nutrient for their growth.
Reflection in a Museum Setting: The Personal Responses Tour
Authors: Gaufberg Elizabeth , Williams Ray
Published: July 2013

Introduction

We describe an educational innovation piloted by the director of education at a university art museum and a physician-educator using the museum holdings as reflective triggers for medical learners. This innovation is distinct from the emerging trend of using art to build observation skills, enhance pattern recognition, and improve diagnostic acumen. Our intervention is specifically designed to promote individual reflection, foster empathy, increase appreciation for the psychosocial context of patient experience, and create a safe haven for learners to deepen their relationships with one another.

Methods

Individuals randomly selected a question from a set prepared by the authors to guide a reflective exploration of the galleries. Each question was different, but all invited an emotional response—a connection between a work of art and some aspect of life or medical practice, for example, “Focus on a memorable patient, and find a work of art that person would find meaningful or powerful” or “Find an image of a person with whom you have difficulty empathizing.” The exploration ended with a shared tour of evocative objects selected by the participants. The duration of the exercise was approximately 1.5 hours and required minimal faculty preparation.

Results

Most of the participants rated the exercise as 5 (excellent) on a 5-point Likert scale and particularly cited the effectiveness at stimulating reflection on meaningful issues and community building.

Discussion

The exercise is easily reproducible in any art gallery space. The same basic format and facilitation technique opens new and different conversations depending on the composition of the group and the choice of artwork. Museum-based reflection warrants further experimentation, analysis, and dissemination.
A New Tool for Testing and Training Ophthalmoscopic Skills
Authors: McCarthy Danielle M. , Leonard Heather R. , Vozenilek John A.
Published: July 2013

Introduction

The direct fundoscopic examination is an important clinical skill, yet the examination is difficult to teach and competency is difficult to assess. Currently there is no defined proficiency assessment for this physical examination, and the objective of this study was to assess the feasibility of a simulation model for evaluating the fundoscopic skills of residents.

Methods

Emergency medicine and ophthalmology residents participated in simulation sessions using a commercially available eye simulator that was modified with customized slides. The slides were designed with the goal of having a quantifiable measure of visualization in addition to a more traditional descriptive outcome. To assess feasibility, participants' ease of use, time to perform the examination, and user satisfaction were assessed.

Results

The simulation could be completed in a timely fashion (mean time per slide, 61–95 seconds), and there were no significant differences in performance between emergency medicine and ophthalmology residents in completion of this task. Residents expressed an interest in fundoscopy through simulation but found this model technically challenging.

Conclusions

This simulation model has potential as a means of training and testing fundoscopy. A concern was low user satisfaction, and further refinement of the model is needed.
An Interactive Handoff Workshop to Improve Intern Readiness in Patient Care Transitions
Authors: Aylward Michael , Vawter Lemuel , Roth Craig
Published: July 2013

Introduction

Patient handoffs are common during residency and are often performed with little or no training. We devised a simple intervention to improve the readiness of interns to perform handoffs.

Methods

We administered a 90-minute interactive workshop during intern orientation in 2009 and 2010. It consisted of a discussion, a case presentation, and a trigger video, followed by debriefing and a role-play exercise. The workshop required minimal technology and materials. Interns were surveyed on their readiness to perform handoffs before and after the workshop as well as 3 to 6 months after the workshop.

Results

Eighty-nine interns participated in the workshop during a 2-year period. Seventy-four survey responses were collected. Self-reported readiness to perform a handoff increased by 26%. A total of 91% and 81% of respondents in 2010 and 2009, respectively, reported using aspects of the workshop up to 6 months later.

Conclusion

A brief workshop can improve interns' readiness to perform handoffs.
Relationship Between Time of First Publication and Subsequent Publication Success Among Non-PhD Physician-Scientists
Authors: Riggs Kevin R. , Reitman Zachary J. , Mielenz Thelma J. , Goodman Philip C.
Published: July 2013

Background

Studies have shown that publication of work during medical school and residency is associated with higher numbers of later publications and citations of published research. However, it is unknown whether this association exists for non-PhD physician-scientists and whether the association persists later into their careers.

Methods

We extracted publication records from the curricula vitae (CVs) of 102 corresponding authors of articles published in 2008 in the New England Journal of Medicine and JAMA, and obtained those authors' citation records from Web of Science. We used regression models to examine the association between time of first publication and later publication and citation rates for the entire postgraduate career and a recent 2-year period.

Results

After adjusting for time since medical school graduation, sex, location of medical school (United States or not United States), and additional non-PhD degrees, we found that authors who first published before graduating from medical school had a greater mean number of publications after medical school and during the period from 2006 to 2007 (164 and 28, respectively) than those who first published during the 5 years afterward (111 and 19, respectively) and those who first published more than 5 years after graduation (59 and 13, respectively). Similarly, authors who first published before graduating from medical school had a greater mean number of citations of their published work since graduation and of publications from 2006 to 2007 (4634 and 333, respectively) than those who first published during the 5 years afterward (2936 and 183, respectively) and those who first published more than 5 years after graduation (1512 and 143, respectively).

Conclusions

Early publication is associated with higher numbers of publications and more citations of published research among non-PhD physician-scientists. This association persists well into a researcher's career.
Why Residents Consider Working Beyond the Duty Hour Limits: Implications of the ACGME 2011 Duty Hour Standards
Authors: Fletcher Kathlyn E. , Nickoloff Sarah , Whittle Jeff , Jackson Jeffrey L. , Frank Michael , Schapira Marilyn M.
Published: July 2013

Background

The Accreditation Council for Graduate Medical Education 2011 duty hour standards became effective on July 1, 2011. One of the new standards allows residents to exceed the limit on continuous duty hours in unusual circumstances relating to patient or family need or rare educational opportunities. There are no data about how often or in what circumstances residents would consider exceeding their duty hour limits using this new provision in the standards. We surveyed internal medicine residents to explore these questions.

Methods

We conducted an anonymous cross-sectional survey of internal medicine residents at a midwestern tertiary-care hospital to determine how often they had considered exceeding duty hour limits in the preceding 2 weeks. We analyzed responses using descriptive statistics and χ2 tests for comparisons.

Results

We obtained responses from 51 of 86 residents (59%). Of those residents, 69% (35/51) indicated that they had wanted to exceed duty hour limits at least once in the prior 2 weeks. The most common reason cited was to provide continuity of care for a patient. The 24 + 6–hour rule was the standard most likely to be broken (cited by 66%; 23/35).

Conclusions

Program leadership should anticipate that residents will commonly identify situations in which they will consider exceeding duty hour limits. It will be important to provide guidance to residents early in the year about the situations that would be appropriate for the application of this new standard.
To Match or Not: Factors Influencing Resident Choice of Graduate Medical Education Program
Authors: Nagler Alisa , Andolsek Kathryn , Schlueter Joanne , Weinerth John
Published: July 2013

Background

Little is known about the factors that influence applicants' decisions to select a graduate medical education training program. Programs may improve their recruitment by better understanding that process.

Methods

Following the Match for the years 2008 though 2010, an electronic survey was sent to 664 applicants to 15 Duke University graduate medical education programs. Those individuals were ranked high enough to match to Duke University but chose to match at another institution. We used quantitative and qualitative analyses to explore factors influencing candidates' decisions and to identify program and institutional improvements to better attract top candidates.

Results

Response rate was 63% (417/664). The quantitative analysis identified factors that were “very important” to applicants (current resident satisfaction, relationship between faculty and residents, collegiality of current residents, quantity and quality of faculty content/mentoring, faculty teaching expertise, diversity of patients and types of procedures, and location), and those that were “not important” to applicants (child care or education opportunities for children, salary, United States Medical Licensing Examination requirements, part-time training options, favorable environment for minorities or women). There were statistically significant differences among specialties. Qualitative analysis identified 3 themes as most influential in their choice: location, program relationships, and the interview experience.

Conclusion

The collection of 3 years of data across specialties identified factors that are important to applicants' choice of a training program. Some factors can be addressed quickly and with little effort, such as the format of the interview day. Others require programs and institutions to revisit their mission, priorities, and training culture to improve relationships between residents and faculty. Programs may wish to be more tactical in selecting the residents and faculty who meet with applicants and be more focused in planning how the interview time is used.
Toward “The Genius of the AND”: Balancing Professionalism and Duty Hour Requirements in Graduate Medical Education
Authors: Stoller James K , Isaacson J. Harry , Nielsen Craig
Published: July 2013

Although enhancing professionalism and ensuring compliance with duty hour regulations both represent important priorities of current graduate medical education, tension in reconciling these goals has been expressed. The term tyranny of the OR has been coined to express the assumption of dichotomous thinking, that is, that we assume we must choose between seemingly competing goals. In contrast, because there is powerful creative value in adopting a bridging mindset, an alternative state called the genius of the AND has been defined to express the benefits of reconciling perceived competing goals.
An Alumni Survey as a Needs Assessment for Curriculum Improvement in Obstetrics and Gynecology
Authors: Curran Diana , Xu Xiao , Dewald Samantha , Johnson Timothy R. B. , Reynolds R. Kevin
Published: July 2013

Background

The Accreditation Council for Graduate Medical Education requirements recommend using outside measures to perform annual residency program evaluations to identify areas for program improvement.

Objective

The aim of the study was to identify areas for residency program improvement via an alumni survey.

Methods

An anonymous online survey was sent to the last 10 years of graduates from our obstetrics and gynecology residency program.

Results

Response rate was 63% (34 of 54). All respondents reported being comfortable serving as gynecologic consultants. More than 75% (26 of 54) reported being comfortable performing abdominal hysterectomies, vaginal hysterectomies, basic and complex laparoscopies, and vaginal surgery. Regarding management of urologic injuries, the participants' responses varied, with 58% (20 of 34) reporting they felt prepared, 21% (7 of 34) with neutral responses, and 21% (7 of 34) reporting they felt unprepared. For total laparoscopic hysterectomy, 65% (22 of 34) reported feeling prepared, 29% (10 of 34) reported they felt unprepared, and 9% (3 of 34) reported they felt neutral. All respondents indicated that he or she would still choose the obstetrics and gynecology residency program at the University of Michigan.

Conclusion

An alumni survey can provide useful outside measures for training programs to assess their effectiveness in preparing their graduates for independent practice. Results of alumni surveys can provide a blueprint for program improvement.