bluuebunny/crossref_metadata_2025 huggingface dataset:
Senior Internal Medicine Residents' Confidence with Essential Topics in Evidence-Based Medicine Taught During Internship
Authors: Keddis Mira T. , Beckman Thomas J. , Cullen Michael W. , Reed Darcy A. , Halvorsen Andrew J. , Wittich Christopher M. , West Colin P. , McDonald Furman S.
Published: July 2013

Background

Few studies have examined residents' retained knowledge and confidence regarding essential evidence-based medicine (EBM) topics.

Objective

To compare postgraduate year-3 (PGY-3) residents' confidence with EBM topics taught during internship with that of PGY-1 residents before and after exposure to an EBM curriculum.

Methods

All residents participated in an EBM curriculum during their intern year. We surveyed residents in 2009. PGY-1 residents completed a Likert-scale type survey (which included questions from the validated Berlin questionnaire and others, developed based on input from local EBM experts). We administered the Berlin questionnaire to a subset of PGY-3 residents.

Results

Forty-five PGY-3 (88%; n  =  51) and 42 PGY-1 (91%; n  =  46) residents completed the survey. Compared with PGY-1 residents pre-curriculum, PGY-3 residents were significantly more confident in their knowledge of pre- and posttest probability (mean difference, 1.14; P  =  .002), number needed to harm (mean difference, 1.09; P  =  .002), likelihood ratio (mean difference, 1.01; P  =  .003), formulation of a focused clinical question (mean difference, 0.98; P  =  .001), and critical appraisal of therapy articles (mean difference, 0.91; P  =  .002). Perceived confidence was significantly lower for PGY-3 than post-curriculum PGY-1 residents on relative risk (mean difference, −0.86; P  =  .002), study design for prognosis questions (mean difference, −0.75; P  =  .004), number needed to harm (mean difference, −0.67; P  =  .01), ability to critically appraise systematic reviews (mean difference, −0.65, P  =  .009), and retrieval of evidence (mean difference, −0.56; P  =  .008), among others. There was no relationship between confidence with and actual knowledge of EBM topics.

Conclusions

Our findings demonstrate lower confidence among PGY-3 than among PGY-1 internal medicine residents for several EBM topics. PGY-3 residents demonstrated poor knowledge of several core topics taught during internship. Longitudinal EBM curricula throughout residency may help reinforce residents' EBM knowledge and their confidence.
Conflict Styles in a Cohort of Graduate Medical Education Administrators, Residents, and Board-Certified Physicians
Authors: Ogunyemi Dotun , Tangchitnob Edward , Mahler Yonathan , Chung Connie , Alexander Carolyn , Korwin Devra
Published: July 2013

Objective

To assess conflict styles and construct validity of the Thomas-Kilmann Mode of Conflict Instrument (TKI) among medical education personnel.

Methods

From 2006 to 2009, 23 board-certified physicians (faculty), 46 residents, and 31 graduate medical education (GME) administrators participated in 3 behavior surveys. We used self-reported data (as completed by participants on the questionnaire). The TKI defines 5 conflict styles: competing, collaborating, compromising, accommodating, and avoiding. The My Best Communication Style Survey assesses 4 styles of communication: bold, expressive, sympathetic, and technical. The Interpersonal Influence Inventory categorizes 4 behavior styles: openly aggressive, assertive, concealed aggressive, and passive behaviors. A P value of < .05 was significant.

Results

Avoiding was the conflict style most chosen, closely followed by compromising and accommodating, whereas collaborating was the least likely to be selected. Collaborating percentiles were highest in GME administrators and lowest in faculty. Competing percentiles decreased from faculty to GME administrators (r  =  −0.237, P  =  .017). Openly aggressive scores were highest in faculty and lowest in GME administrators (P  =  .028). Technical communication scores were highest in residents and lowest in GME administrators (P  =  .008). Technical communication scores were highest in African Americans (P  =  .000). Asian Americans were more likely to be high in accommodating style (P  =  .019). Midwest respondents selected the collaborating style more than others did (41.3% versus 25%) (P  =  .009). Competing conflict style correlated positively with openly aggressive behavior and bold communication but negatively with expressive and sympathetic communications.

Conclusion

There are differences in behavior patterns among faculty, residents, and GME administrators with suggestions of ethnic and geographic influences. Correlation among instruments supported theoretical relationships of construct validity.
Residents' Awareness of Racial and Ethnic Disparities in Cardiovascular Care
Authors: Greysen S. Ryan , Siegel Bruce , Sears Vickie , Solomon Allen , Jones Karen , Bradley Elizabeth H
Published: July 2013

Purpose

To characterize attitudes of residents toward racial/ethnic disparities in health care and to explore the effect of a simple intervention to improve awareness of these disparities.

Methods

The authors surveyed residents in internal and emergency medicine rotating through the Coronary Care Unit of a major teaching hospital about their attitudes toward disparities in cardiovascular care before and after an intervention that fostered discussion of evidence for the existence of disparities, possible causes of disparities, and clinically focused approaches to quality improvement tailored to the residents' practice environment.

Results

Before the intervention, 35% of residents agreed that racial/ethnic disparities might occur for patients within the US health care system in general, and only 7% agreed that patients they personally treated might experience racial/ethnic disparities in healthcare. These proportions increased significantly after the intervention: 85% agreement at level of US health care system and 32% at the level of individual practice (P < .001). Changes in awareness did not differ by sex, postgraduate year of training, race/ethnicity, reported prior diversity training, or plans to subspecialize.

Conclusion

Awareness of racial/ethnic disparities in care among residents remains low, particularly at the level of individual practice, but is amenable to intervention.
Patient Follow-up in an Urban Resident Continuity Clinic: An Initiative to Improve Scheduling Practices
Authors: Dowdy David W. , Horton Claire K. , Lau Ben , Ferrer Rosaly , Chen Alice H.
Published: July 2013

Introduction

Failure to schedule timely follow-up appointments may impair continuity and quality of care, especially for patients with low health literacy and unstable living situations. Resident continuity clinics face particular challenges in scheduling patient follow-up because of residents' complex schedules and limited time in clinic.

Methods

As part of a structured quality-improvement curriculum, residents initiated discussions with clinical supervisors and clerical staff to evaluate and improve scheduling practices in an urban continuity clinic. The problem-solving process emphasized feasibility (rapid implementation/evaluation cycle, low time/resource burden) and measurable outcomes. These discussions led to design of a new scheduling form. We evaluated the short-term impact of awareness raising by comparing scheduling rates before (month 1) versus after (months 2–3) implementation, and of the form itself by randomly selecting 2 afternoon clinics to implement the new form, with a third serving as control.

Results

We analyzed all patient encounters over a 3-month period (n  =  910), excluding patients with a recommended follow-up interval of greater than 4 months. The proportion of appointments “never scheduled” (at 1 month after provider-requested follow-up date) declined from 18.8% (95% confidence interval [CI], 14.5%–23.9%) in month 1 to 11.4% (CI, 8.1%–15.5%) in month 3. This proportion was significantly higher before than after implementation of the form (multivariable relative risk, 1.49; 95% CI, 1.08–2.03; P  =  .02), both in clinics that used and did not use the form (P  =  .93 for difference).

Conclusions

We describe a model resident-led, team-based intervention that addressed core competencies in graduate medical education while improving outpatient scheduling practices.
Developing a Cultural Consensus Analysis Based on the Internal Medicine Milestones (M-CCA)
Authors: Smith C. Scott , Hill William , Francovich Chris , Morris Magdalena , Langlois-Winkle Francine , Caverzagie Kelly , Iobst William
Published: July 2013

A national task force identified domains and developmental milestones from the national competencies for resident training. Cultural Consensus Analysis (CCA) is a standard anthropological technique that can identify value conflicts. We created a CCA based on the internal medicine milestones (M-CCA) in 3 steps: converted the 38 domains into active statements; reduced the total number to 12 by summarizing and combining; and simplified the wording. This M-CCA needs further validation, after which it may be useful for assessing the 6-competency model.
Addressing the Scholarly Activity Requirements for Residents: One Program's Solution
Authors: Carek Peter J , Dickerson Lori M , Diaz Vanessa A , Steyer Terrence E
Published: July 2013

Background

Scholarly activity as a component of residency education is becoming increasingly emphasized by the Accreditation Council for Graduate Medical Education. “Limited or no evidence of resident or faculty scholarly activity” is a common citation given to family medicine residency programs by the Review Committee for Family Medicine.

Objective

The objective was to provide a model scholarly activity curriculum that has been successful in improving the quality of graduate medical education in a family medicine residency program, as evidenced by a record of resident academic presentations and publications.

Methods

We provide a description of the Clinical Scholars Program that has been implemented into the curriculum of the Trident/Medical University of South Carolina Family Medicine Residency Program.

Results

During the most recent 10-year academic period (2000–2010), a total of 111 residents completed training and participated in the Clinical Scholars Program. This program has produced more than 24 presentations during national and international meetings of medical societies and 15 publications in peer-reviewed medical journals. In addition, many of the projects have been presented during meetings of state and regional medical organizations.

Conclusions

This paper presents a model curriculum for teaching about scholarship to family medicine residents. The success of this program is evidenced by the numerous presentations and publications by participating residents.
Efficacy of Peer-Assisted Learning Across Residencies for Procedural Training in Dermatology
Authors: Duran-Nelson Alisa , Baum Karyn D , Weber-Main Anne Marie , Menk Jeremiah
Published: July 2013

Background

With new care models such as the medical home, there is an expanding need for primary care providers to be trained in dermatologic procedures. Yet, many internal medicine residency program graduates feel unprepared to perform these procedures. The aim of this study was to evaluate the effect of a structured peer-assisted learning approach to improve residents' knowledge and skills related to common dermatologic assessment techniques.

Methods

Eight medicine-dermatology resident educators, with a faculty member, facilitated dermatologic procedure workshops for 28 internal medicine and medicine-pediatrics resident learners. Learners completed preworkshop and postworkshop surveys, assessing their knowledge and skill levels as well as the efficacy of the resident educators and the educational value of the workshop as a whole.

Results

All learners were able to properly demonstrate the techniques at the workshop's conclusion. The median sum score of self-reported knowledge increased from 3 to 9.5 (scale, 0–10; P < .001). The median sum score of self-reported skills increased from 10 to 16 (scale, 4–20; P < .001). Resident educators were favorably evaluated by their peers, and 96% of participants rated the experience as being of high educational value.

Conclusion

Peer-assisted learning is effective in teaching dermatologic procedures in graduate medical education. Resident learners found peer-assisted learning to be beneficial and rated their peer teachers highly. Further studies should focus on outcomes in practice, looking at the number of dermatologic procedures performed by learners, as well as the effects on resident educators.
Development of an Institutional Resident Curriculum in Communication Skills
Authors: Joyce Barbara L. , Scher Eric , Steenbergh Timothy , Voutt-Goos Mary J.
Published: July 2013

Objective

We describe a collaboration between the graduate medical education office and the Henry Ford Health System's Office of Clinical Quality and Safety to create an institution-wide communication skills curriculum pertinent to the institution's safety and patient- and family-centered care initiatives.

Methods

A multidisciplinary committee provided oversight for the curriculum design and used sentinel event and other quality and safety data to identify specific target areas. The curriculum consisted of 3 courses: “Informed Consent,” “Sharing Bad News,” and “Disclosure of Unanticipated Events.” Each course included 3 components: a multimedia online module; small group discussions led by the program director that focused on the use of communication scripts; and 2 objective structured clinical examinations (OSCEs) requiring residents to demonstrate use of the communication scripts. All first-year residents (N  =  145) and faculty (N  =  30) from 20 residency programs participated in this initiative. Evaluation of the residents consisted of a self-assessment; the standardized patients' assessment of the residents' performance; and faculty assessment of resident performance with verbal feedback.

Results

Survey data showed that residents found the courses valuable, with residents identifying communication scripts they would use in clinical settings. Focus groups with faculty highlighted that the resident debriefing sessions provided them with insight into a resident's communication skills early in their training.

Conclusion

Our institutional curriculum was developed in a collaborative manner, and used an evidence-based approach to teach communication skills relevant to institutional safety and quality initiatives. Other institutions may wish to adopt our strategy of departmental collaboration and alignment of resident education with institutional initiatives.
A Structured Workshop to Improve the Quality of Resident Discharge Summaries
Authors: Talwalkar Jaideep S. , Ouellette Jason R. , Alston Shawnette , Buller Gregory K. , Cottrell Daniel , Genese Thomas , Vaezy Ali
Published: July 2013

Background

Poor communication at hospital discharge can increase the risk of adverse events. The hospital discharge summary is the most common tool for detailing events related to hospitalization in preparation for postdischarge follow-up, yet deficiencies in discharge summaries have been widely reported. Resident physicians are expected to dictate discharge summaries but receive little formal training in this arena. We hypothesized that implementation of an educational program on chart documentation skills would result in improvements in the quality of hospital discharge summaries in a community hospital internal medicine residency program.

Methods

A monthly, 1-hour workshop was launched in August 2007 to provide consistent and ongoing instruction on chart documentation. Guided by a faculty moderator, residents reviewed 2 randomly selected peer chart notes per session using instruments developed for that purpose. After the workshop had been in place for 2 years, 4 faculty members reviewed 63 randomly selected discharge summaries from spring 2007, spring 2008, and spring 2009 using a 14-item evaluation tool.

Results

Mean scores for 10 of the 14 individual items improved in a stepwise manner during the 3 years of the study. Items related to overall quality of the discharge summary showed statistically significant improvement, as did the portion of the summaries “carbon copied” to the responsible outpatient physician.

Conclusions

The quality of hospital discharge summaries improved following the implementation of a novel, structured program to teach chart documentation skills. Ongoing improvement was seen 1 and 2 years into the program, suggesting that continuing instruction in those skills was beneficial.
Equipping Residents to Address Alcohol and Drug Abuse: The National SBIRT Residency Training Project
Authors: Pringle Janice L. , Kowalchuk Alicia , Meyers Jessica Adams , Seale J. Paul
Published: July 2013

Background

The Screening, Brief Intervention and Referral to Treatment (SBIRT) service for unhealthy alcohol use has been shown to be one of the most cost-effective medical preventive services and has been associated with long-term reductions in alcohol use and health care utilization. Recent studies also indicate that SBIRT reduces illicit drug use. In 2008 and 2009, the Substance Abuse Mental Health Service Administration funded 17 grantees to develop and implement medical residency training programs that teach residents how to provide SBIRT services for individuals with alcohol and drug misuse conditions. This paper presents the curricular activities associated with this initiative.

Methods

We used an online survey delivery application (Qualtrics) to e-mail a survey instrument developed by the project directors of 4 SBIRT residency programs to each residency grantee's director. The survey included both quantitative and qualitative data.

Results

All 17 (100%) grantees responded. Respondents encompassed residency programs in emergency medicine, family medicine, pediatrics, obstetrics-gynecology, psychiatry, surgery, and preventive medicine. Thirteen of 17 (76%) grantee programs used both online and in-person approaches to deliver the curriculum. All 17 grantees incorporated motivational interviewing and validated screening instruments in the curriculum. As of June 2011, 2867 residents had been trained, and project directors reported all residents were incorporating SBIRT into their practices. Consistently mentioned challenges in implementing an SBIRT curriculum included finding time in residents' schedules for the modules and the need for trained faculty to verify resident competence.

Conclusions

The SBIRT initiative has resulted in rapid development of educational programs and a cohort of residents who utilize SBIRT in practice. Skills verification, program dissemination, and sustainability after grant funding ends remain ongoing challenges.
Educational Experiences Residents Perceive As Most Helpful for the Acquisition of the ACGME Competencies
Authors: Guerrero Lourdes R. , Baillie Susan , Wimmers Paul , Parker Neil
Published: July 2013

Background

The Accreditation Council for Graduate Medical Education (ACGME) requires physicians in training to be educated in 6 competencies considered important for independent medical practice. There is little information about the experiences that residents feel contribute most to the acquisition of the competencies.

Objective

To understand how residents perceive their learning of the ACGME competencies and to determine which educational activities were most helpful in acquiring these competencies.

Method

A web-based survey created by the graduate medical education office for institutional program monitoring and evaluation was sent to all residents in ACGME-accredited programs at the David Geffen School of Medicine, University of California-Los Angeles, from 2007 to 2010. Residents responded to questions about the adequacy of their learning for each of the 6 competencies and which learning activities were most helpful in competency acquisition.

Results

We analyzed 1378 responses collected from postgraduate year-1 (PGY-1) to PGY-3 residents in 12 different residency programs, surveyed between 2007 and 2010. The overall response rate varied by year (66%–82%). Most residents (80%–97%) stated that their learning of the 6 ACGME competencies was “adequate.” Patient care activities and observation of attending physicians and peers were listed as the 2 most helpful learning activities for acquiring the 6 competencies.

Conclusion

Our findings reinforce the importance of learning from role models during patient care activities and the heterogeneity of learning activities needed for acquiring all 6 competencies.
Impact of a Resident-as-Teacher Workshop on Teaching Behavior of Interns and Learning Outcomes of Medical Students
Authors: Hill Andrew G. , Srinivasa Sanket , Hawken Susan J. , Barrow Mark , Farrell Susan E. , Hattie John , Yu Tzu-Chieh
Published: July 2013

Background

Residents and interns are recognized as important clinical teachers and mentors. Resident-as-teacher training programs are known to improve resident attitudes and perceptions toward teaching, as well as their theoretical knowledge, skills, and teaching behavior. The effect of resident-as-teacher programs on learning outcomes of medical students, however, remains unknown. An intervention cohort study was conducted to prospectively investigate the effects of a teacher-training workshop on teaching behavior of participating interns and on the clerkship learning outcomes of instructed fourth-year medical students.

Methods

The House Officer-as-Teacher Training Workshop was implemented in November 2009 over 1.5 days and attended by all 34 interns from one teaching hospital. Subsequently, between February and August 2010, 124 fourth-year medical students rated the observable teaching behavior of interns during 6-week general surgery clerkships at this intervention hospital as well as at 2 comparable hospitals serving as control sites. Ratings were collected using an anonymous 15-item Intern Clinical Teaching Effectiveness Instrument. Student achievement of clerkship learning outcomes during this period was evaluated using a validated and centralized objective structured clinical examination.

Results

Medical students completed 101 intern clinical teaching effectiveness instruments. Intern teaching behavior at the intervention hospital was found to be significantly more positive, compared with observed behavior at the control hospitals. Objective structured clinical examination results, however, did not demonstrate any significant intersite differences in student achievement of general surgery clerkship learning outcomes.

Conclusions

The House Officer-as-Teacher Training Workshop noticeably improved teaching behavior of surgical interns during general surgery clerkships. This improvement did not, however, translate into improved achievement of clerkship learning outcomes by medical students during the study period.
Deliberate Practice Improves Obstetrics and Gynecology Residents' Hysteroscopy Skills
Authors: Rackow Beth W. , Solnik M. Jonathon , Tu Frank F. , Senapati Sangeeta , Pozolo Kristen E. , Du Hongyan
Published: July 2013

Introduction

Development of surgical skills is an integral component of residency education in obstetrics and gynecology.

Objective

We report data from a supervised, deliberate, dry lab practice in hysteroscopy for junior obstetrics-gynecology residents, undertaken to evaluate whether simulation training improved hysteroscopy performance to a skill level similar to that of senior residents.

Methods

A prospective, comparative, multicenter trial compared Objective Structured Assessment Of Technical Skills (OSATS) performance of 2 groups: 19 postgraduate year (PGY)-1 and PGY-2 and 18 PGY-3 and PGY-4 Ob-Gyn residents. PGY-1 and PGY-2 participants underwent 4 sessions of brief, deliberate, focused training in hysteroscope assembly and operative hysteroscopic polypectomy using uterine models. Subsequently, all participants completed a simulated hysteroscopic polypectomy OSATS, and procedure times and structured assessment scores were compared among groups.

Results

PGY-1 and PGY-2 residents who had completed OSATS training performed at or above the level of untrained PGY-3 and PGY-4 residents. Junior residents had better assembly times and scores, resection scores, and global skills scores (P < .05). Resection times did not differ between groups but differed among institutions.

Discussion

Brief, hands-on training sessions, which were task-specific and repetitive facilitated short-term gains in learning operative hysteroscopy and increased the dry lab skill level of junior residents compared to that of senior residents. This curriculum was effectively implemented at 3 institutions and generated comparable results, suggesting generalizability.
A Didactic and Experiential Quality Improvement Curriculum for Psychiatry Residents
Authors: Reardon Claudia L. , Ogrinc Greg , Walaszek Art
Published: July 2013

Background

Quality improvement (QI) education in residency training is important and necessary for accreditation. Although the literature on this topic has been growing, some specialties, in particular psychiatry, have been underrepresented.

Methods

We developed a didactic and experiential QI curriculum within a US psychiatry residency program that included a seminar series and development of QI projects. Evaluation included resident knowledge using the Quality Improvement Knowledge Application Tool, implementation of resident QI projects, and qualitative and quantitative satisfaction with the curriculum.

Results

Our curriculum significantly improved QI knowledge in 2 cohorts of residents (N  =  16) as measured by the Quality Improvement Knowledge Application Tool. All resident QI projects (100%) in the first cohort were implemented. Residents and faculty reported satisfaction with the curriculum.

Conclusions

Our curriculum incorporated QI education through didactic and experiential learning in a moderately sized US psychiatry residency program. Important factors included a longitudinal experience with protected time for residents to develop QI projects and a process for developing faculty competence in QI. Further studies should use a control group of residents and examine interprofessional QI curricula.
Education in Professionalism: Results from a Survey of Pediatric Residency Program Directors
Authors: Kesselheim Jennifer C. , Sectish Theodore C. , Joffe Steven
Published: July 2013

Background

The Accreditation Council for Graduate Medical Education (ACGME) requires pediatric residency programs to teach professionalism but does not provide concrete guidance for fulfilling these requirements. Individual programs, therefore, adopt their own methods for teaching and evaluating professionalism, and published research demonstrating how to satisfy the ACGME professionalism requirement is lacking.

Methods

We surveyed pediatric residency program directors in 2008 to explore the establishment of expectations for professional conduct, the educational experiences used to foster learning in professionalism, and the evaluation of professionalism.

Results

Surveys were completed by 96 of 189 program directors (51%). A majority reported that new interns attend a session during which expectations for professionalism are conveyed, either verbally (93%) or in writing (65%). However, most program directors reported that “None or Few” of their residents engaged in multiple educational experiences that could foster learning in professionalism. Despite the identification of professionalism as a core competency, a minority (28%) of programs had a written curriculum in ethics or professionalism. When evaluating professionalism, the most frequently used assessment strategies were rated as “very useful” by only a modest proportion (26%–54%) of respondents.

Conclusions

Few programs have written curricula in professionalism, and opportunities for experiential learning in professionalism may be limited. In addition, program directors express only moderate satisfaction with current strategies for evaluating professionalism that were available through 2008.
Postinterview Communication between Obstetrics and Gynecology Residency Programs and Candidates
Authors: Curran Diana S. , Andreatta Pamela B. , Xu Xiao , Nugent Clark E. , Dewald Samantha R. , Johnson Timothy R. B.
Published: July 2013

Introduction

Residency programs seek to match the best candidates with their positions. To avoid ethical conflicts in this process, the National Residency Matching Program (NRMP or Match) has rules regarding appropriate conduct, including guidelines on contact between candidates and programs. Our study examined communication between obstetrics and gynecology (Ob-Gyn) programs and residency candidates after interviewing and prior to ranking.

Methods

Ob-Gyn program directors in the United States were sent a self-administered survey via e-mail. Data were collected and analyzed using descriptive methods to examine communication practices of these programs.

Results

The response rate was 40%. The findings showed that respondents had variable interpretations of the NRMP rules and suggest that programs may be communicating their match intentions especially to favored candidates. Respondents' open text comments highlighted program directors' frustrations with current NRMP rules.

Discussion

NRMP communication rules are intended to minimize pressure on residency candidates. Our findings suggest they may be leading to unforeseen stresses on program directors and candidates.

Conclusions

As educational leaders in medicine, we must consider what professional communications are acceptable without increasing the pressure on candidates during the ranking and match process.
Use of an Integrated, Anatomic-Based, Orthopaedic Resident Education Curriculum: A 5-Year Retrospective Review of Its Impact on Orthopaedic In-Training Examination Scores
Authors: Klena Joel C. , Graham Jove H. , Lutton Jeffrey S. , Temple Jessica L. , Beck John David
Published: July 2013

Introduction

Experts have called for a comprehensive didactic curriculum in orthopaedic residency training. This study examined the effects of an anatomic-based, integrated conference program on annual Orthopaedic In-Training Examination (OITE) scores at a single orthopaedic residency program.

Methods

We implemented a new, integrated, anatomic-based curriculum in January 2005. Differences between scores were analyzed by postgraduate year (PGY) of training. OITE scores (percentile ranking and raw scores) of year 1 (PGY-2) through year 4 (PGY-5) residents exposed to the curriculum (2005–2009) were compared to prior PGY-2 through PGY-5 residents (2000–2004) who had experienced the previous unstructured curriculum. To evaluate for cohort effects, United States Medical Licensing Examination (USMLE) Step I scores for these 2 groups were also compared.

Results

Eight residents were exposed to the new conference program and 8 to the prior conference program. All residents' percentile rankings improved after exposure to the curriculum, although improvement was not statistically significant for all participants. The most dramatic improvements in OITE scores were seen for PGY-4 and PGY-5 residents, which improved from 65th to 91st percentile (P  =  .03) and from 66th to 91st percentile (P  =  .06), respectively. There were no differences between the cohorts in USMLE Step I scores.

Discussion

Initiation of an integrated, anatomic-based, resident conference program had a positive impact on resident performance on the OITE.
An Alternative Practice Model: Residents Transform Continuity Clinic and Become Systems Thinkers
Authors: Colbert Colleen Y. , Myers John D. , Cable Christian T. , Ogden Paul E. , Mirkes Curtis , McNeal Tresa , Skeen Shawn
Published: July 2013

Background

A changing health care environment has created a need for physicians trained in health system improvement. Residency programs have struggled to teach and assess practice-based learning and improvement and systems-based practice competencies, particularly within ambulatory settings.

Intervention

We describe a resident-created and resident-led quality and practice-improvement council in an internal medicine continuity clinic. We conducted focus groups and report on residents' perspectives on council membership, practice management experiences, quality improvement projects, and resident satisfaction.

Method

Focus groups were held from May 2009 to March 2010 with internal medicine residents (N  =  5/focus group) who participated in the Continuity Clinic Ownership in Resident Education (CCORE) council. Data were analyzed with a grounded theory approach.

Results

During the focus groups, residents responded to the question: “Do you have any new insights into delivering quality patient care in an outpatient clinic as a result of this experience (CCORE membership)?” The qualitative analysis resulted in 6 themes: systems thinking and systems-based care skills; improving quality of patient care; improved clinic efficiency; ownership of patients; need for improved communication of practice changes; and a springboard for research.

Conclusions

CCORE residents participated in system changes and acquired leadership skills while working on practice-based and system problems in a clinic microsystem. We believe this model can be implemented by other residency programs to promote the development of systems thinking in residents, increase their ownership of continuity clinic, and empower them to implement system changes.
Impact of the Medical Liability Crisis on Postresidency Training and Practice Decisions in Obstetrics-Gynecology
Authors: Blanchard May Hsieh , Ramsey Patrick S. , Gala Rajiv B. , Bannerman Cynthia Gyamfi , Srinivas Sindhu K. , Hernandez-Rey Armando E.
Published: July 2013

Introduction

The liability crisis may affect residency graduates' practice decisions, yet structured liability education during residency is still inadequate. The objective of this study was to determine the influence of medical liability on practice decisions and to evaluate the adequacy of current medical liability curricula.

Methods

All fourth-year residents (n  =  1274) in 264 Accreditation Council for Graduate Medical Education–accredited allopathic and 25 osteopathic US obstetrics and gynecology residency training programs were asked to participate in a survey about postgraduate plans and formal education during residency regarding liability issues in 2006. Programs were identified by the Council on Resident Education in Obstetrics and Gynecology directory and the American College of Osteopathic Obstetricians and Gynecologists residency program registry. Outcome measures were the reported influence of liability/malpractice concerns on postresidency practice decision making and the incidence of formal education in liability/malpractice issues during residency.

Results

A total of 506 of 1274 respondents (39.7%) returned surveys. Women were more likely than men to report “region of the country” (P  =  .02) and “paid malpractice insurance as a salaried employee” (P  =  .03) as a major influence. Of the respondents, 123 (24.3%) planned fellowship training, and 229 (45.3%) were considering limiting practice. More than 20% had been named in a lawsuit. Respondents cited Pennsylvania, Florida, and New York as locations to avoid. In response to questions about medical liability education, 54.3% reported formal education on risk management, and 65.2% indicated they had not received training on “next steps” after a lawsuit.

Discussion

Residents identify liability-related issues as major influences when making choices about practice after training. Structured education on matters of medical liability during residency is still inadequate.
Correlation Between Self-Reported Resident Duty Hours and Time-Stamped Parking Data
Authors: Chadaga Smitha R. , Keniston Angela , Casey Dan , Albert Richard K.
Published: July 2013

Background

Failure to comply with Accreditation Council for Graduate Medical Education-mandated resident work hour limitations can result in citations and shortened accreditation cycles. Many programs assess compliance by collecting self-reports of work hours from each resident.

Objectives

To examine residents' self-reported assessment of work hours recorded on a daily basis using a Web-based product with electronically recorded times collected as residents entered and exited the parking garage.

Methods

Study participants consisted of 62 University of Colorado Denver internal medicine residents rotating at Denver Health Medical Center on a monthly basis over a 4-month period. Self-reported data submitted by 60 residents were compared with the times these residents entered and exited from the parking garage at Denver Health Medical Center, as assessed by an electronic badge reader.

Results

A high level of agreement was found between these two data sets. No significant difference was found between the time-stamped parking data and self-reported Web-based data for resident work hours.

Conclusions

Residents accurately self-reported their work hours, using a daily Web-based duty hours log when compared to an independent, objective and blinded assessment of work hours.
“Page Me if You Need Me”: The Hidden Curriculum of Attending-Resident Communication
Authors: Loo Lawrence , Puri Nishant , Kim Daniel I. , Kawayeh Anas , Baz Samuel , Hegstad Douglas
Published: July 2013

Background

Discrepancies exist between what resident and attending physicians perceive as adequate supervision. We documented current practices in a university-based, categoric, internal medicine residency to characterize these discrepancies and the types of mixed messages that are communicated to residents, as well as to assess their potential effect on resident supervision and patient safety.

Methods

We surveyed residents and attending physicians separately about their current attitudes and behaviors regarding resident supervision. Both groups responded to 2 different measures of resident supervision: (1) 6 clinical vignettes that involved patient safety concerns, and (2) 9 frequently reported phrases communicated by attending physicians to residents before leaving the hospital during on-call admission days.

Results

There were clear and substantial differences between the perceptions of resident and attending physicians about when the supervising attending physician should be notified in each of the 6 vignettes. For example, 85% of attending physicians reported they wanted to be notified of an unexpected pneumothorax that required chest tube placement, but only 31% of resident physicians said they would call their attending physician during those circumstances. Common phrases, such as “page me if you need me,” resulted in approximately 50% of residents reporting they would “rarely” or “never” call and another 41% reporting they would only “sometimes” call their attending physicians.

Conclusions

Our study found that attending physicians reported they would want more frequent communication and closer supervision than routinely perceived by resident physicians. Although this discrepancy exists, commonly used phrases, such as “page me if you need me,” rarely resulted in a change in resident behavior, and attending physicians appeared to be aware of the ineffectiveness of these statements. These mixed messages may increase the difficulty of balancing the dual goals of appropriate attending supervision and progressive independence during residency training.
Impact of a Computer-Based Diagnostic Decision Support Tool on the Differential Diagnoses of Medicine Residents
Authors: Feldman Mitchell J. , Hoffer Edward P. , Barnett G. Octo , Kim Richard J. , Famiglietti Kathleen T. , Chueh Henry C.
Published: July 2013

Background

Computer-based medical diagnostic decision support systems have been used for decades, initially as stand-alone applications. More recent versions have been tested for their effectiveness in enhancing the diagnostic ability of clinicians.

Objective

To determine if viewing a rank-ordered list of diagnostic possibilities from a medical diagnostic decision support system improves residents' differential diagnoses or management plans.

Method

Twenty first-year internal medicine residents at Massachusetts General Hospital viewed 3 deidentified case descriptions of real patients. All residents completed a web-based questionnaire, entering the differential diagnosis and management plan before and after seeing the diagnostic decision support system's suggested list of diseases. In all 3 exercises, the actual case diagnosis was first on the system's list. Each resident served as his or her own control (pretest/posttest).

Results

For all 3 cases, a substantial percentage of residents changed their primary considered diagnosis after reviewing the system's suggested diagnoses, and a number of residents who had not initially listed a “further action” (laboratory test, imaging study, or referral) added or changed their management options after using the system. Many residents (20% to 65% depending on the case) improved their differential diagnosis from before to after viewing the system's suggestions. The average time to complete all 3 cases was 15.4 minutes. Most residents thought that viewing the medical diagnostic decision support system's list of suggestions was helpful.

Conclusion

Viewing a rank-ordered list of diagnostic possibilities from a diagnostic decision support tool had a significant beneficial effect on the quality of first-year medicine residents' differential diagnoses and management plans.
Plug the Leak: Align Public Spending With Public Need
Authors: Girard Donald E. , Brunett Patrick , Cedfeldt Andrea , Bower Elizabeth A. , Flores Christine , Rajhbeharrysingh Uma , Choi Dongseok
Published: July 2013

We explore the history behind the current structure of graduate medical education funding and the problems with continuing along the current funding path. We then offer suggestions for change that could potentially manage this health care spill. Some of these changes include attracting more students into primary care, aligning federal graduate medical education spending with future workforce needs, and training physicians with skills they will require to practice in systems of the future.
County Jail as a Novel Site for Obstetrics and Gynecology Resident Education
Authors: Sufrin Carolyn B. , Autry Amy M. , Harris Kathryn L. , Goldenson Joe , Steinauer Jody E.
Published: July 2013

Introduction

Obstetrics and gynecology residents benefit from providing care to diverse patient populations and increasing their awareness of the social determinants of health.

Objectives

To describe and evaluate an outpatient rotation for obstetrics and gynecology residents at a county jail.

Methods

A comprehensive curriculum incorporating Accreditation Council for Graduate Medical Education (ACGME) core competencies was designed for all first-year residents to rotate weekly at the local county jail during their 6-week ambulatory care block. Residents completed an anonymous online evaluation and wrote a reflective essay at the end of the rotation. Data for patient visits were tabulated.

Results

All 9 first-year residents completed the rotation and the evaluation. Seventy-eight percent of patient visits were for gynecologic services, predominantly family planning. Residents reported that the rotation overall was a positive experience, emphasizing the unique intersection between psychosocial issues and health care in the jail setting. Rotation objectives that satisfied the 6 ACGME competencies were met.

Discussion

Providing care to incarcerated women through a structured curriculum is a novel way to encourage obstetrics and gynecology residents to consider the social determinants of health and for residents to cultivate their counseling skills. The rotation also included a wide breadth and depth of clinical diagnoses and procedures. Obstetrics and gynecology residency programs should consider a curriculum in reproductive health for incarcerated women.
Global Health Fellowships: A National, Cross-Disciplinary Survey of US Training Opportunities
Authors: Nelson Brett D. , Izadnegahdar Rasa , Hall Lauren , Lee Patrick T.
Published: July 2013

Introduction

Medical trainee interest and participation in global health programs have been growing at unprecedented rates, and the response has been increasing opportunities for medical students and residents. However, at the fellowship level, the number and types of global health training opportunities across specialties have not previously been characterized.

Methods

A cross-sectional survey was conducted between November and December 2010 among all identified global health fellowship programs in the United States. Programs were identified through review of academic and institutional websites, peer-reviewed literature, web-based search engines, and epidemiologic snowball sampling. Identified global health fellowship programs were invited through e-mail invitation and follow-up telephone calls to participate in the web-based survey questionnaire.

Results

The survey identified 80 global health fellowship programs: 31 in emergency medicine, 14 in family medicine, 11 in internal medicine, 10 in pediatrics, 8 interdisciplinary programs, 3 in surgery, and 3 in women's health. Of these, 46 of the programs (57.5%) responded to the survey. Fellowship programs were most commonly between 19 and 24 months in duration and were nearly equally divided among 2 models: (1) fellowship integrated into residency, and (2) fellowship following completion of residency. Respondents also provided information on selection criteria for fellows, fellowship training activities, and graduates' career choices. Nearly half of fellowship programs surveyed were recently established and had not graduated fellows at the time of the study.

Conclusion

Institutions across the nation have established a significant, diverse collection of global health fellowship opportunities. A public online database (www.globalhealthfellowships.org), developed from the results of this study, will serve as an ongoing resource on global health fellowships and best practices.
High-Fidelity Simulation as an Experiential Model for Teaching Root Cause Analysis
Authors: Quraishi Sadeq A. , Kimatian Stephen J. , Murray W. Bosseau , Sinz Elizabeth H.
Published: July 2013

Purpose

The purpose of this study was to assess the effectiveness of high-fidelity simulation for teaching root cause analysis (RCA) in graduate medical education.

Methods

Thirty clinical anesthesiology-1 through clinical anesthesiology-3 residents were randomly assigned to 2 groups: group A participants received a 10-minute lecture on RCA and participated in a simulation exercise where a medical error occurs, and group B participants received the 10-minute lecture on RCA only. Participants completed baseline, postintervention, and 6-month follow-up assessments, and they were evaluated on their attitude toward as well as understanding of RCA and “systems-based” care.

Results

All 30 residents completed the surveys. Baseline attitudes and knowledge scores were similar between groups. Postintervention knowledge scores were also similar between groups; however, group B was significantly more skeptical (P < .001) about the use of RCA and “systems improvement” strategies. Six months later, group A demonstrated retained knowledge scores and unchanged attitude, whereas group B demonstrated significantly worse knowledge scores (P  =  .001) as well as continued skepticism toward a systems-based approach (P < .001) to medical error reduction.

Conclusion

High-fidelity simulation in conjunction with focused didactics is an effective strategy for teaching RCA and systems theory in graduate medical education. Our findings also suggest that there is greater retention of knowledge and increased positive attitude toward systems improvement when focused didactics are coupled with a high-fidelity simulation exercise.