bluuebunny/crossref_metadata_2025 huggingface dataset:
The Pediatrics Milestones: Conceptual Framework, Guiding Principles, and Approach to Development
Authors: Hicks Patricia J. , Schumacher Daniel J. , Benson Bradley J. , Burke Ann E. , Englander Robert , Guralnick Susan , Ludwig Stephen , Carraccio Carol
Published: July 2013

Background

The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Pediatrics (ABP) have partnered to initiate the Pediatrics Milestone Project to further refine the 6 ACGME competencies and to set performance standards as part of the continued commitment to document outcomes of training and program effectiveness.

Intervention

Members of the Pediatrics Milestone Project Working Group searched the medical literature and beyond to create a synopsis of models and evidence for a developmental ontogeny of the elements for 52 subcompetencies. For each subcompetency, we created a series of Milestones, grounded in the literature. The milestones were vetted with the entire working group, engaging in an iterative process of revisions until reaching consensus that their narrative descriptions (1) included all critical elements, (2) were behaviorally based, (3) were properly sequenced, and (4) represented the educational continuum of training and practice.

Outcomes

We have completed the first iteration of milestones for all subcompetencies. For each milestone, a synopsis of relevant literature provides background, references, and a conceptual framework. These milestones provide narrative descriptions of behaviors that represent the ontogeny of knowledge, skill, and attitude development across the educational continuum of training and practice.

Discussion

The pediatrics milestones take us a step closer to meaningful outcome assessment. Next steps include undertaking rigorous study, making appropriate modifications, and setting performance standards. Our aim is to assist program directors in making more reliable and valid judgments as to whether a resident is a “good doctor” and to provide outcome evidence regarding the program's success in developing doctors.
Educational Excellence in a Crowded Emergency Department: Consensus Recommendations From the Council of Emergency Medicine Residency Directors 2010
Authors: Lin Michelle , Taira Taku , Promes Susan , Regan Linda
Published: July 2013

Objective

Emergency Department (ED) crowding is a major public health problem and one that has not been well studied for its effects on education. The objective of this article was to identify best-practice, consensus recommendations to help emergency medicine (EM) residency programs and faculty maintain educational excellence in an era of ED crowding.

Methods

A geographically diverse group of 37 clinician-educator leaders in EM convened at the 2010 Council of Emergency Medicine Residency Directors Academic Assembly. The participants discussed innovative ideas and solutions to address the many educational challenges that ED crowding poses.

Results

To cope with crowding, the consensus group identified 3 educational domains, focusing on the educator, the learner, and the institutional system. Core subthemes included optimizing teaching opportunities, providing alternative teaching approaches, and redefining what faculty and learners traditionally think of as teaching. An ED rotation provides ample opportunities for teaching not only about patient care and medical knowledge but also other Accreditation Council for Graduate Medical Education competencies, such as interpersonal and communication skills, professionalism, and system-based practice.

Conclusions

Crowding in EDs poses educational challenges, but with some creativity, flexibility, and desire to make the most of a challenging situation, educational excellence is an achievable goal.
Mainstreaming Risk Management Education Into New Resident and Fellow Orientation
Authors: McMyler Eileen T , Ross Paula T , Saran Kelly A , Urteaga-Fuentes Anabel , Anderson Susan G , Boothman Richard C , Lypson Monica L
Published: July 2013

Introduction

Understanding patient safety events and causative factors is an important step in reducing preventable adverse events. The University of Michigan's Graduate Medical Education (GME) Office, Department of Risk Management (DRM), and Office of Clinical Affairs (OCA) collaborated to incorporate a video workshop as a formal introduction to patient safety during orientation for new residents and fellows. This workshop reinforced the importance of effective communication and supervision in patient safety.

Methods

DRM and OCA produced a video depicting an actual, unanticipated outcome that resulted from a constellation of preventable circumstances, which allows the audience to observe communication and supervision issues that lead to a patient death. The video is followed by a discussion of the patient safety issues seen, why they occurred, and strategies for improvement. Trainee perceptions of the value of the experience were surveyed and collected using a qualitative survey.

Results

Most responders found the video workshop helpful. Trainees perceived the video and facilitated discussion as an effective way to identify patient safety issues, available resources, and the culture of patient safety at the institution.

Conclusion

Trainee comments supported the video workshop as an effective way to highlight the importance of communication and supervision in relation to patient safety. In the future, the DRM, OCA, and GME hope to reinforce this shared vision of patient safety through combined educational efforts.
Progress Toward Improving the Quality of Cardiac Arrest Medical Team Responses at an Academic Teaching Hospital
Authors: Didwania Aashish , McGaghie William C. , Cohen Elaine R. , Butter John , Barsuk Jeffrey H. , Wade Leonard D. , Chester Rozanna , Wayne Diane B.
Published: July 2013

Background

Internal medicine (IM) residents who undergo simulation-based advanced cardiac life support (ACLS) training are significantly more likely to manage actual events according to American Heart Association (AHA) standards than nontrained residents. How long ACLS skills are retained is unknown.

Methods

We conducted a retrospective case-control study of ACLS responses from January to June 2008 and reviewed medical records to assess adherence to AHA standards. Cases and controls are team responses to ACLS events divided into those directed by postgraduate year 2 (PGY-2) IM resident leaders versus those managed by PGY-3 IM resident leaders. Residents in 2008 completed an educational program featuring deliberate practice in ACLS using a human patient simulator during their second year. Medical records of ACLS events were reviewed to assess adherence to AHA guidelines. We evaluated the effects of simulation training on quality of ACLS care during the 2008 period and in comparison with historical 2004 data.

Results

In 2008, 1 year after simulation training, PGY-3 residents showed the same adherence to AHA standards (88% [SD, 17%]) as that of PGY-2 residents who were newly simulator trained (86% [SD, 18%]) (P  =  .77). Previously, in 2004, PGY-2 simulator-trained residents showed significantly higher adherence to AHA standards (68% [SD, 20%]) than nonsimulator-trained PGY-3 residents (44% [SD, 20%]) (P < .001). All resident groups in 2008 outperformed their 2004 peers.

Conclusions

Improved quality of ACLS care was maintained by 2008 PGY-3 simulator-trained residents 1 year after training, likely due to skill retention rather than increased clinical experience, as a prior cohort of PGY-3 residents did not perform as well as PGY-2 residents in actual ACLS care. Our results confirm prior work regarding the impact of simulation-based education to improve the quality of actual patient care.
Pediatric Residents' Learning Styles and Temperaments and Their Relationships to Standardized Test Scores
Authors: Tuli Sanjeev Y. , Thompson Lindsay A. , Saliba Heidi , Black Erik W. , Ryan Kathleen A. , Kelly Maria N. , Novak Maureen , Mellott Jane , Tuli Sonal S.
Published: July 2013

Background

Board certification is an important professional qualification and a prerequisite for credentialing, and the Accreditation Council for Graduate Medical Education (ACGME) assesses board certification rates as a component of residency program effectiveness. To date, research has shown that preresidency measures, including National Board of Medical Examiners scores, Alpha Omega Alpha Honor Medical Society membership, or medical school grades poorly predict postresidency board examination scores. However, learning styles and temperament have been identified as factors that may affect test-taking performance. The purpose of this study is to characterize the learning styles and temperaments of pediatric residents and to evaluate their relationships to yearly in-service and postresidency board examination scores.

Methods

This cross-sectional study analyzed the learning styles and temperaments of current and past pediatric residents by administration of 3 validated tools: the Kolb Learning Style Inventory, the Keirsey Temperament Sorter, and the Felder-Silverman Learning Style test. These results were compared with known, normative, general and medical population data and evaluated for correlation to in-service examination and postresidency board examination scores.

Results

The predominant learning style for pediatric residents was converging 44% (33 of 75 residents) and the predominant temperament was guardian 61% (34 of 56 residents). The learning style and temperament distribution of the residents was significantly different from published population data (P  =  .002 and .04, respectively). Learning styles, with one exception, were found to be unrelated to standardized test scores.

Conclusions

The predominant learning style and temperament of pediatric residents is significantly different than that of the populations of general and medical trainees. However, learning styles and temperament do not predict outcomes on standardized in-service and board examinations in pediatric residents.
Pediatrics Milestone Project: Next Steps Toward Meaningful Outcomes Assessment
Authors: Hicks Patricia J. , Englander Robert , Schumacher Daniel J. , Burke Ann , Benson Bradley J. , Guralnick Susan , Ludwig Stephen , Carraccio Carol
Published: July 2013

In the September 2010 issue of JGME, the Pediatric Milestones Working Group published “The Pediatrics Milestones: Conceptual Framework, Guiding Principles, and Approach to Development”, a document that describes the construction of the first iteration of the Pediatric Milestones. These Milestones were developed by the Working Group as a group of practical behavioral expectations for each of the 52 sub-competencies. In constructing these Milestones, the authors were cognizant of the need to ground the Milestones themselves in evidence, theories or other conceptual frameworks that would provide the basis for the ontogeny of development for each sub-competency. During this next phase of the Milestones development, the process will continue with consultation with content experts and consideration of assessment of Milestones. We have described possible measurement tools, explored threats to validity, establishment of benchmarks, and possible approaches to reporting of performance. The vision of the Pediatrics Milestone Project is to understand the development of a pediatrician from entry into medical school through the twilight of a physician’s career, and the work will require a collaborative effort of the undergraduate and graduate medical education communities, and the accrediting and certifying bodies.
Feasibility of an Internet-Based Global Ranking Instrument
Authors: Mudumbai Seshadri C , Gaba David M , Boulet John , Howard Steven K , Davies M. Frances
Published: July 2013

Background

Single-item global ratings are commonly used at the end of undergraduate clerkships and residency rotations to measure specific competencies and/or to compare the performances of individuals against their peers. We hypothesized that an Internet-based instrument would be feasible to adequately distinguish high- and low-ability residents.

Materials and Methods

After receiving Institutional Review Board approval, we developed an Internet-based global ranking instrument to rank 42 third-year residents (21 in 2008 and 21 in 2009) in a major university teaching hospital's department of anesthesiology. Evaluators were anesthesia attendings and nonphysicians in 3 tertiary-referral hospitals. Evaluators were asked this ranking question: “When it comes to overall clinical ability, how does this individual compare to all their peers?”

Results

For 2008, 111 evaluators completed the ranking exercise; for 2009, 79 completed it. Residents were rank-ordered using the median of evaluator categorizations and the frequency of ratings per assigned relative performance quintile. Across evaluator groups and study years, the summary evaluation data consistently distinguished the top and bottom resident cohorts.

Discussion

An Internet-based instrument, using a single-item global ranking, demonstrated feasibility and can be used to differentiate top- and bottom-performing cohorts. Although ranking individuals yields norm-referenced measures of ability, successfully identifying poorly performing residents using online technologies is efficient and will be useful in developing and administering targeted evaluation and remediation programs.
Incoming Resident Interest in Global Health: Occasional Travel Versus A Future Career Abroad?
Authors: Birnberg Jonathan M , Lypson Monica , Anderson R. Andy , Theodosis Christian , Kim Jimin , Olopade Olufunmilayo I , Arora Vineet M
Published: July 2013

Background

While there is growing interest among residents in participating in international health experiences, it is unclear whether this interest will translate into intentions to pursue a global health career. We aimed to describe overall interest in and career intentions toward global health among interns.

Methods

We administered an anonymous survey to incoming interns in all specializations during graduate medical education orientation at 3 teaching hospitals affiliated with 2 Midwestern US medical schools in June 2009. Survey domains included demographics, previous global health experiences, interest in and barriers to participating in global health experiences during residency, and plans to pursue a future global health career.

Results

Response rate was 87% (299 of 345 residents). The most commonly reported barriers to participating in global health experiences were scheduling (82%) and financial (80%) concerns. Two-thirds of interns (65%) reported they were likely to focus on global health in their future career. Of those envisioning a global health career, 77% of interns reported interest in participating in short, occasional trips in the future; and 23% of interns intended to pursue a part-time or full-time career abroad. Interns committed to a career abroad were more willing to use vacation time (73% vs. 40% of all others, respectively; P < .001) or to personally finance the trip (58% vs. 27% of all others, respectively; P  =  < .001), and were less concerned about personal safety than interns not committed (9% vs. 26% of all others, respectively; P  =  .01).

Conclusions

Although a large proportion of incoming interns report interest in global health careers, few are committed to a global health career. Medical educators could acknowledge career plans in global health when developing global health curricula.
The Impact of ACGME Work-Hour Reforms on the Operative Experience of Fellows in Surgical Subspecialty Programs
Authors: Simien Christopher , Holt Kathleen D , Richter Thomas H
Published: July 2013

Background

In July 2003, the Accreditation Council for Graduate Medical Education (ACGME) introduced a set of regulations that mandated a reduction in the number of hours that medical residents can work. These requirements have generated controversy among medical educators, with some expressing concern that reducing resident hours may limit clinical exposure and competency, particularly in surgical specialties.

Objective

This study examines the impact of duty hour restrictions on resident operative experience in residents in 2 surgical subspecialties since the implementation of the ACGME duty hour limits.

Method

We examined operative log data for vascular surgery and pediatric surgery, using the academic year immediately preceding the duty hour restrictions, 2002 to 2003, as a baseline for comparison to subsequent academic years through 2006 to 2007 for vascular surgery and 2007 to 2008 for pediatric surgery.

Results

Graduating fellows in pediatric surgery showed no change in their total operative volume following duty hour restrictions. The pediatric-defined category of neonate procedures showed an increase following duty hour restrictions. Graduating fellows in vascular surgery showed an increase in total major procedures as surgeon. The vascular-defined categories of endovascular-diagnostic, endovascular-therapeutic, and endovascular-graft procedures also increased.

Conclusions

The reduction of duty hours has not resulted in a decrease in operative volume as some have predicted. Operative volume in pediatric surgery remained mainly unchanged, whereas operative volume in vascular surgery increased. We explore possible explanations for the observed findings.
Using a Web-Based Survey for the Annual Internal Medicine Residency Evaluation
Authors: Ethnasios Ramez , Rotblatt Michael , Wali Soma
Published: July 2013

Background

The Accreditation Council for Graduate Medical Education requires annual surveys of residency programs.

Intervention

We switched from a paper-based to a web-based survey and report on the efficiency and quality improvement gains from this change. To determine the prevalence of web-based surveys, we conducted a web-based and telephone survey of 17 internal medicine residency training programs in Southern California. Fifteen programs provided data (88% response rate).

Results

By making the switch, our internal medicine residency program was able to save over 50 administrative hours and over 1000 pieces of paper. A total investment of $20 for the Surveymonkey.com account (Palo Alto, CA) and approximately 15 hours to migrate the survey was made. The program administrators were able to more rapidly analyze and respond to the feedback from the residents with this system. Our survey of other programs showed that of 15 programs, 12 used a web-based survey system (80%) and 3 used a paper-based system (20%). Surveymonkey.com was the most popular system used.

Conclusions

We feel that the quality of response to resident feedback was enhanced by the real-time reaction to comments and assessments. Residents also appreciated the benefits of such a change. We recommend this approach to other programs that are still using paper-based surveys.
Graduate Medical Education Leadership Development Curriculum for Program Directors
Authors: Haan Constance K. , Zenni Elisa A. , West Denise T. , Genuardi Frank J.
Published: July 2013

Objective

Program director (PD) orientation to roles and responsibilities takes on many forms and processes. This article describes one institution's innovative arm of faculty development directed specifically toward PDs and associate PDs to provide institutional resources and information for those in graduate medical education leadership roles.

Methods

The designated institutional official created a separate faculty development curriculum for leadership development of PDs and associate PDs, modeled on the Association of American Medical Colleges-GRA (Group on Resident Affairs) graduate medical education leadership development course for designated institutional officials. It consists of monthly 90-minute sessions at the end of a working day, for new and experienced PDs alike, with mentoring provided by experienced PDs. We describe 2 iterations of the curriculum. To provide ongoing support a longitudinal curriculum of special topics has followed in the interval between core curriculum offerings.

Results

Communication between PDs across disciplines has improved. The broad, inclusive nature allowed for experienced PDs to take advantage of the learning opportunity while providing exchange and mentorship through sharing of lessons learned. The participants rated the course highly and education process and outcome measures for the programs have been positive, including increased accreditation cycle lengths.

Conclusion

It is important and valuable to provide PDs and associate PDs with administrative leadership development and resources, separate from general faculty development, to meet their role-specific needs for orientation and development and to better equip them to meet graduate medical education leadership challenges. This endeavor provides a foundational platform for designated institutional official and PD interactions to work on program building and improvement.
The Importance of International Medical Rotations in Selection of an Otolaryngology Residency
Authors: Boyd Nathan H , Cruz Raul M
Published: July 2013

Background

The objective of this study was to determine the extent of interest in international electives among prospective otolaryngology residents and to determine whether the availability of international electives affected students' interest in ranking a particular residency program.

Methods

A 3-part survey was given to all medical students enrolled in the 2008 otolaryngology match via the Electronic Residency Application Service. Part 1 elicited demographic information. Part 2 explored general interest in international rotations. Part 3 involved ranking several factors affecting students' choice of residency programs. This survey was developed at our institution, with no formal validation. Participation was anonymous and voluntary.

Results

A total of 307 students entered the otolaryngology match, and 55 surveys (18%) were completed. Twenty-five of 55 students (55%) had completed an international elective during or prior to medical school, and 51 of 55 respondents (93%) had a “strong” or “very strong” desire to participate in an international elective during residency; 48 of 55 students (87%) had a “strong” or “very strong” desire to participate in international surgical missions after residency. Future practice goals had no correlation with interest in international rotations, either during or after residency training. Respondents ranked 8 factors that had an impact on residency program selection in the following order of importance: operative experience, location, lifestyle, research opportunities, didactics, international electives, prestige of program, and salary.

Conclusion

Interest in international medicine among prospective otolaryngologists was high in this subset of respondents but did not appear to affect residency program selection.
Missed Appointments in Resident Continuity Clinic: Patient Characteristics and Health Care Outcomes
Authors: Nguyen Douglas L , DeJesus Ramona S , Wieland Mark L
Published: July 2013

Background

Frequent missed patient appointments in resident continuity clinic is a well-documented problem, but whether rates of missed appointments are disproportionate to standard academic practice, what patient factors contribute to these differences, and health care outcomes of patients who frequently miss appointments are unclear.

Methods

The overall population for the study was composed of patients in an academic internal medicine continuity clinic with 5 or more office visits between January 2006 and December 2008. We randomly selected 325 patients seen by resident physicians and 325 patients cared for by faculty. Multivariate linear regression was used to examine the relationship between patient factors and missed appointments. Health outcomes were compared between patients with frequent missed appointments and the remainder of the study sample, using Cox regression analysis.

Results

Resident patients demonstrated significantly higher rates of missed appointments than faculty patients, but this difference was explained by patient factors. Factors associated with more missed appointments included use of a medical interpreter, Medicaid insurance, more frequent emergency department visits, less time impanelled in the practice, and lower proportion of office visits with the primary care provider. Patients with frequent missed appointments were less likely to be up to date with preventive health services and more likely to have poorly controlled blood pressure and diabetes.

Conclusions

We found that the disproportionate frequency of missed appointments in resident continuity clinic is explained by patient factors and practice discontinuity, and that patients with frequent missed appointments demonstrated worse health care outcomes.
Using a Simulated Surgical Skills Station to Assess Laceration Management by Surgical and Nonsurgical Residents
Authors: Fargo Matthew V , Edwards John A , Roth Bernard J , Short Matthew W
Published: July 2013

Objective

To assess laceration management performance among surgical and nonsurgical postgraduate year-1 (PGY-1) residents objectively and to test for interval improvement.

Methods

From 2006 to 2008, 106 PGY-1 residents from 10 medical specialties were evaluated with a simulated surgical skills station using pigs' feet before and after internship. Subjects were given 11 minutes to choose the proper suture, prepare and close the wound, and answer laceration management questions. Trainees were classified as surgical (emergency medicine, general surgery, obstetrics and gynecology, orthopedics, and otolaryngology) and nonsurgical (family medicine, internal medicine, neurology, pediatrics, and transitional year). An objective checklist was used to assess performance.

Results

A total of 106 PGY-1 residents (age range, 25–44 years; mean, 28.7 years) participated, consisting of 41 surgical (39%) and 65 nonsurgical residents (61%). Surgical group scores improved from 78.4% to 87.7% (P < .001). Nonsurgical scores improved from 67.2% to 73.1% (P < .001). There was similar improvement between groups (surgical, 9.4%; nonsurgical, 5.9%; P  =  .21). Surgical residents outscored nonsurgical residents before (P < .001) and after (P < .001) internship.

Conclusion

Surgical residents outperformed nonsurgical residents before and after the PGY-1 year with similar score improvements. A simulated surgical skills station can be used to evaluate procedure performance objectively and to test for interval improvement. A simulated surgical skills station may serve as a useful adjunct to apprenticeship in assessing procedure competence.
Senior Pediatric Residents as Teachers for an Innovative Multidisciplinary Mock Code Curriculum
Authors: Sweeney Alison , Stephany Alyssa , Whicker Shari , Bookman Jack , Turner David A
Published: July 2013

Background

Resuscitation education for pediatric residents may be limited due to the low frequency of actual codes in children. Mock codes represent an opportunity to increase trainee education in acute resuscitations, and we designed a unique multidisciplinary mock code curriculum that uses senior pediatric residents as teachers.

Methods

A novel mock code curriculum was designed and integrated into an existing night-float rotation. Our 2-tiered curriculum not only focuses on improving teaching proficiency for resident educators (REs) but also includes separate goals to augment simulation-based resuscitation education for resident participants (RPs) and the multidisciplinary staff.

Results

Seventy-six residents (17 REs, 59 RPs) and more than 75 nurses have participated in the curriculum. After participation, 100% of residents felt that this curriculum would improve the quality of actual resuscitations, and 94% of RPs reported receiving valuable feedback. Comfort with teaching and feedback increased for REs (P < .05), and comfort in resuscitation and crisis resource management improved for RPs (P < .05). The nursing staff also felt that communication, teamwork, and collaboration improved due to implementation of this curriculum.

Conclusions

A unique mock code curriculum can improve resident comfort with teaching, peer facilitation, feedback, and resuscitation. Curricular interventions of this nature may also be able to improve the balance between service and education within a residency training program. As we move toward a competency based training model within graduate medical education, further investigation is needed to link educational modifications of this nature to clinical outcomes and actual resident performance.
A Collaborative Model for Inpatient Training in a Small Pediatric Residency Program
Authors: Carr Anna M , Irigoyen Matilde , Arbeter Allan M , Wimmer Robert S , McGregor Robert S , Reed Charles R , Schidlow Daniel V
Published: July 2013

Background

The nationwide decline in pediatric admissions to community hospitals threatens the sustainability of small pediatric residency programs. Little is known about the response of small programs to this challenge.

Objectives

We report on the design and evaluation of an innovative, collaborative model for pediatric inpatient training between an academic community medical center and a children's hospital.

Methods

We describe the operational, academic, and financial features of the model. Outcome measures include patient volume and subspecialty mix, resident and faculty perceptions as reported in an anonymous survey, and Accreditation Council for Graduate Medical Education Residency Review Committee (RRC) review.

Results

In 2003, Albert Einstein Medical Center (Einstein) closed its pediatric inpatient unit and established an independent teaching service at St Christopher's Hospital for Children (St Christopher's) in Philadelphia, Pennsylvania. Under the new model, patient volume and subspecialty mix more than tripled. Einstein residents and faculty identified 5 major strengths: level of responsibility and decision making, caring for medically complex children, quality of teaching, teamwork, and opportunity to participate in academic activities at a children's hospital. St Christopher's leadership reported increased volume, no disruption of their residency program, and no dilution of clinical teaching material. The Einstein program was reaccredited by the RRC in 2006 for 2 years and in 2009 for 4 years.

Conclusion

A collaborative model for inpatient training was successful in maintaining a community hospital–based pediatric residency program. Positive outcomes were documented for the residency program, the parent community hospital, and the collaborating children's hospital.
Enhancing Teamwork Between Chief Residents and Residency Program Directors: Description and Outcomes of an Experiential Workshop
Authors: McPhillips Heather A. , Frohna John G. , Murad M. Hassan , Batra Maneesh , Panda Mukta , Miller Marsha A. , Brigham Timothy P. , Doughty Robert A.
Published: July 2013

Background

An effective working relationship between chief residents and residency program directors is critical to a residency program's success. Despite the importance of this relationship, few studies have explored the characteristics of an effective program director-chief resident partnership or how to facilitate collaboration between the 2 roles, which collectively are important to program quality and resident satisfaction. We describe the development and impact of a novel workshop that paired program directors with their incoming chief residents to facilitate improved partnerships.

Methods

The Accreditation Council for Graduate Medical Education sponsored a full-day workshop for residency program directors and their incoming chief residents. Sessions focused on increased understanding of personality styles, using experiential learning, and open communication between chief residents and program directors, related to feedback and expectations of each other. Participants completed an anonymous survey immediately after the workshop and again 8 months later to assess its long-term impact.

Results

Participants found the workshop to be a valuable experience, with comments revealing common themes. Program directors and chief residents expect each other to act as a role model for the residents, be approachable and available, and to be transparent and fair in their decision-making processes; both groups wanted feedback on performance and clear expectations from each other for roles and responsibilities; and both groups identified the need to be innovative and supportive of changes in the program. Respondents to the follow-up survey reported that workshop participation improved their relationships with their co-chiefs and program directors.

Conclusion

Participation in this experiential workshop improved the working relationships between chief residents and program directors. The themes that were identified can be used to foster communication between incoming chief residents and residency directors and to develop a curriculum for chief resident development.
Comparative Reliability of Structured Versus Unstructured Interviews in the Admission Process of a Residency Program
Authors: Blouin Danielle , Day Andrew G. , Pavlov Andrey
Published: July 2013

Background

Although never directly compared, structured interviews are reported as being more reliable than unstructured interviews. This study compared the reliability of both types of interview when applied to a common pool of applicants for positions in an emergency medicine residency program.

Methods

In 2008, one structured interview was added to the two unstructured interviews traditionally used in our resident selection process. A formal job analysis using the critical incident technique guided the development of the structured interview tool. This tool consisted of 7 scenarios assessing 4 of the domains deemed essential for success as a resident in this program. The traditional interview tool assessed 5 general criteria. In addition to these criteria, the unstructured panel members were asked to rate each candidate on the same 4 essential domains rated by the structured panel members. All 3 panels interviewed all candidates. Main outcomes were the overall, interitem, and interrater reliabilities, the correlations between interview panels, and the dimensionality of each interview tool.

Results

Thirty candidates were interviewed. The overall reliability reached 0.43 for the structured interview, and 0.81 and 0.71 for the unstructured interviews. Analyses of the variance components showed a high interrater, low interitem reliability for the structured interview, and a high interrater, high interitem reliability for the unstructured interviews. The summary measures from the 2 unstructured interviews were significantly correlated, but neither was correlated with the structured interview. Only the structured interview was multidimensional.

Conclusions

A structured interview did not yield a higher overall reliability than both unstructured interviews. The lower reliability is explained by a lower interitem reliability, which in turn is due to the multidimensionality of the interview tool. Both unstructured panels consistently rated a single dimension, even when prompted to assess the 4 specific domains established as essential to succeed in this residency program.
Effects of Education on Interns' Verbal and Electronic Handoff Documentation Skills
Authors: Airan-Javia Subha L. , Kogan Jennifer R. , Smith Megan , Lapin Jennifer , Shea Judy A. , Dine C. Jessica , Ishida Koto , Myers Jennifer S.
Published: July 2013

Background

Improving handoff communications is a National Patient Safety Goal. Interns and residents are rarely taught how to safely handoff their patients. Our objective was to determine whether teaching safe handoff principles would improve handoff quality.

Methods

Our study was conducted on the inpatient services at 2 teaching hospitals. In this single-institution, randomized controlled trial, internal medicine interns (N  =  44) and residents (N  =  24) participated in a 45-minute educational session on safe handoff communication skills. Residents received additional education on effective feedback practices and were asked to provide each intern with structured feedback. Quality of interns' electronic and verbal handoffs was measured by using a Handoff Evaluation Tool created by the authors. The frequency of handoff communication failures was also assessed through semistructured phone interviews of postcall interns.

Results

Interns who received handoff education demonstrated superior verbal handoff skills than control interns (P < .001), while no difference was seen in electronic handoff skills. Communication failures related to code status (P < .001) and overnight tasks (P < .050) were less frequent in the intervention group.

Conclusions

Interns' electronic handoff documentation skills did not improve with the intervention. This may reflect greater difficulty in changing physicians' electronic documentation habits.
Using a Commercially Available Web-Based Evaluation System to Enhance Residents' Teaching
Authors: Keller Jennifer M. , Blatt Benjamin , Plack Margaret , Gaba Nancy D. , Greenberg Larrie
Published: July 2013

Background

Residents-as-teachers (RATs) programs have been shown to improve trainees' teaching skills, yet these decline over time.

Intervention

We adapted a commercial Web-based system to maintain resident teaching skills through reflection and deliberate practice and assessed the system's ability to (1) prevent deterioration of resident teaching skills and (2) provide information to improve residents' teaching skills and teaching program quality.

Methods

Ten first-year obstetrics-gynecology (Ob-Gyn) residents participated in a RATs program. Following the program, they used a commercial evaluation system to complete self-assessments of their teaching encounters with medical students. Students also evaluated the residents. To assess the system's effectiveness, we compared these residents to historical controls with an Objective Structured Teaching Examination (OSTE) and analyzed the ratings and the free text comments of residents and students to explore teaching challenges and improve the RATs program.

Results

The intervention group outscored the control group on the OSTE (mean score ± SD  =  81 ± 8 versus 74 ± 7; P  =  .05, using a 2-tailed Student t-test). Rating scale analysis showed resident self-assessments were consistently lower than student evaluations, with the difference reaching statistical significance in 3 of 6 skills (P < .05). Comments revealed that residents most valued using innovative teaching techniques, while students most valued a positive educational climate and interpersonal connections with residents. Recommended targets for RATs program improvement included teaching feedback, time-limited teaching, and modeling professionalism behaviors.

Conclusions

Our novel electronic Web-based reinforcement system shows promise in preventing deterioration of resident teaching skills learned during an Ob-Gyn RATs program. The system also was effective in gaining resident and student insights to improve RATs programs. Because our intervention was built upon a commercially available program, our approach could prove useful to the large population of current subscribers.
Narrative, Written Sign-Outs and Interns' and Senior Medical Students' Confidence: A Randomized, Controlled Crossover Trial
Authors: Chuang Elizabeth , Ark Tavinder K. , LoCurcio Michael
Published: July 2013

Background

Failures of communication during the transfer of patient care errors.

Methods

We created a new format for written sign-out material, based on aviation industry practice and cognitive psychology theory, designed to improve interns' and senior medical students' communication during transfers of patient care responsibility. We carried out a randomized, blinded, crossover trial, comparing a new, narrative, written sign-out report to a usual written sign-out. Thirty-two interns and fourth-year medical students rated their confidence across various clinical tasks and answered clinical questions regarding hypothetical patients presented to them in written, new, narrative sign-out compared with the customary format.

Results

There was no statistical difference in confidence when interns and senior medical students received usual versus narrative sign-outs.

Conclusions

Although a limited measure suggested some improvement in competence, the narrative format did not improve participants' self-rated confidence during patient-care transfer.
Developing Educators, Investigators, and Leaders During Internal Medicine Residency: The Area of Distinction Program
Authors: Kohlwes R. Jeffrey , Cornett Patricia , Dandu Madhavi , Julian Katherine , Vidyarthi Arpana , Minichiello Tracy , Shunk Rebecca , Jain Sharad , Harleman Elizabeth , Ranji Sumant , Sharpe Brad , O'Sullivan Patricia , Hollander Harry
Published: July 2013

Background

Professional organizations have called for individualized training approaches, as well as for opportunities for resident scholarship, to ensure that internal medicine residents have sufficient knowledge and experience to make informed career choices.

Context and Purpose

To address these training issues within the University of California, San Francisco, internal medicine program, we created the Areas of Distinction (AoD) program to supplement regular clinical duties with specialized curricula designed to engage residents in clinical research, global health, health equities, medical education, molecular medicine, or physician leadership. We describe our AoD program and present this initiative's evaluation data.

Methods and Program Evaluation

We evaluated features of our AoD program, including program enrollment, resident satisfaction, recruitment surveys, quantity of scholarly products, and the results of our resident's certifying examination scores. Finally, we described the costs of implementing and maintaining the AoDs.

Results

AoD enrollment increased from 81% to 98% during the past 5 years. Both quantitative and qualitative data demonstrated a positive effect on recruitment and improved resident satisfaction with the program, and the number and breadth of scholarly presentations have increased without an adverse effect on our board certification pass rate.

Conclusions

The AoD system led to favorable outcomes in the domains of resident recruitment, satisfaction, scholarship, and board performance. Our intervention showed that residents can successfully obtain clinical training while engaging in specialized education beyond the bounds of core medicine training. Nurturing these interests may empower residents to better shape their careers by providing earlier insight into internist roles that transcend classic internal medicine training.
Assessing the Impact of Innovative Training of Family Physicians for the Patient-Centered Medical Home
Authors: Carney Patricia A. , Eiff M. Patrice , Saultz John W. , Lindbloom Erik , Waller Elaine , Jones Samuel , Osborn Jamie , Green Larry
Published: July 2013

Background

New approaches to enhance access in primary care necessitate change in the model for residency education.

Purpose

To describe instrument design, development and testing, and data collection strategies for residency programs, continuity clinics, residents, and program graduates participating in the Preparing the Personal Physician for Practice (P4) project.

Methods

We developed and pilot-tested surveys to assess demographic characteristics of residents, clinical and operational features of the continuity clinics and educational programs, and attitudes about and implementation status of Patient Centered Medical Home (PCMH) characteristics. Surveys were administered annually to P4 residency programs since the project started in 2007. Descriptive statistics were used to profile data from the P4 baseline year.

Results

Most P4 residents were non-Hispanic white women (60.7%), married or partnered, attended medical school in the United States and were the first physicians in their families to attend medical school. Nearly 85% of residency continuity clinics were family health centers, and about 8% were federally qualified health centers. The most likely PCMH features in continuity clinics were having an electronic health record and having fully secure remote access available; both of which were found in more than 50% of continuity clinics. Approximately one-half of continuity clinics used the electronic health record for safety projects, and nearly 60% used it for quality-improvement projects.

Conclusions

We created a collaborative evaluation model in all 14 P4 residencies. Successful implementation of new surveys revealed important baseline features of residencies and residents that are pertinent to studying the effects of new training models for the PCMH.
The Relative Influence of Available Resources During the Residency Match: A National Survey of Canadian Medical Students
Authors: Blissett Sarah , Law Christine , Morra Dante , Ginsburg Shiphra
Published: July 2013

Background

Many medical students find choosing a residency challenging. There are several steps involved, including determining one's own priorities, arranging electives, choosing a training program and site, and preparing an in-depth application and a rank order list. Many resources are available to assist students, including the Canadian Resident Matching Service website, program websites, career counselors, career information sessions, mentors, peers, family/friends, and the Canadian Medical Residency Guide. Our study explored the relative impact of these resources on the career decision-making process.

Method

We invited medical students in their final year at 12 Canadian medical schools to complete an online survey. Questions included identifying the relative utility of resources in the context of each component of the decision-making process. Responses were analyzed using descriptive statistics.

Results

The response rate was 71% (1076 of 1518). Overall, mentors, family/friends, and peers had the most impact on students' decision making. Career counselors, websites, and the Canadian Medical Residency Guide had much less impact. Family/friends were most frequently cited as essential to the process; however, family/friends and peers were equal in having some impact.

Conclusions

Our findings suggest that students are most influenced by family, friends, and peers, who are not involved in the formal residency selection effort. Appreciating the impact of these influences on students' decision making is important to understanding how they decide on their future careers. The study supports continuation of mentorship programs. Future work could focus on qualitative research to further characterize resource use.