bluuebunny/crossref_metadata_2025 huggingface dataset:
Baseline Sleep Dysfunction Among Matriculating Interns
Authors: Pulliam Samantha J. , Weinstein Debra F. , Malhotra Atul , Macklin Eric A. , Berkowitz Lori R.
Published: July 2013

Background

Work hour limitations for graduate medical trainees, motivated by concerns about patient safety, quality of care, and trainee well-being, continue to generate controversy. Little information about sleep habits and the prevalence of sleep disorders among residents is available to inform policy in this area.

Objectives

To evaluate the sleep habits of matriculating residents, postgraduate year-1 (PGY-1).

Design

An anonymous, voluntary, self-administered survey study was used with 3 validated questionnaires: the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, and the Epworth Sleepiness Scale, which were fielded to PGY-1 residents entering the Accreditation Council for Graduate Medical Education–accredited programs at Massachusetts General Hospital and/or Brigham and Women's Hospitals in June and July 2009.

Results

Of 355 eligible subjects, 310 (87%) participated. Mean sleep time for PGY-1 residents was 7 hours and 34 minutes, and 5.6% of PGY-1 residents had Pittsburgh Sleep Quality Index global scores greater than 5, indicating poor quality sleep. Using multiple linear and ordinal logistic regression models, men had higher Pittsburgh Sleep Quality Index sleep latency scores, whereas women and those with children had higher Epworth Sleepiness Scale daytime sleepiness scores, and 18% of PGY-1 residents had abnormal amounts of daytime sleepiness based on the Epworth Sleepiness Scale. The Insomnia Severity Index identified 4.2% of PGY-1 residents with moderate insomnia.

Conclusions

Some PGY-1 residents may begin residency with sleep dysfunctions. Efforts to provide targeted help to selected trainees in managing fatigue during residency should be investigated.
Implementing a Multifaceted Quality-Improvement Curriculum in an Obstetrics-Gynecology Resident Continuity-Clinic Setting: A 4-Year Experience
Authors: Sepulveda Debra , Varaklis Kalli
Published: July 2013

Background

Although many residency programs are instituting quality improvement (QI) curricula in response to both institutional and external mandates, there are few reports of successful integration of resident initiated projects into these QI curricula with documented impact on health care processes and measures.

Intervention

We introduced a multifaceted curriculum into an Obstetrics-Gynecology continuity clinic. Following a needs assessment, we developed a didactic session to introduce residents to QI tools and the how to of a mentored resident-initiated project. Resident projects were presented to peers and faculty and were evaluated. A postgraduation survey assessed residents' satisfaction with the curriculum and preparedness for involvement in QI initiatives after residency. We also assessed whether this resulted in sustained improvement in health care measures.

Results

The curriculum was presented to 7 classes of residents (n  =  25) and 17 resident initiated projects have been completed. Twenty-one residents (84%) completed the preintervention survey and 12 of 17 (71%) residents who completed the entire curriculum completed the postintervention survey. Sustained change in surrogate health measures was documented for 4 projects focused on improving clinical measures, and improvement in clinical systems was sustained in 9 of the remaining 13 projects (69%). Most of the respondents (75%, n  =  9) agreed or strongly agreed that the projects done in residency provided a helpful foundation to their current QI efforts.

Conclusion

This project successfully demonstrates that a multifaceted program in QI education can be implemented in a busy Obstetrics-Gynecology residency program, resulting in sustained improvement in surrogate health measures and in clinical systems. A longitudinal model for resident projects results in an opportunity for reflection, project revision, and a maintenance plan for continued clinical impact.
The Radar Graph: the Development of an Educational Tool to Demonstrate Resident Competency
Authors: Keister Drew M. , Larson Daniel , Dostal Julie , Baglia Jay
Published: July 2013

Background

Despite the movement toward competency-based assessment by accrediting bodies in recent years, there is no consensus on how to best assess medical competence. Direct observation is a useful tool. At the same time, a comprehensive assessment system based on direct observation has been difficult to develop.

Intervention

We developed a system that translates data obtained from checklists of observed behaviors completed during educational activities, including direct observation of clinical care, into a graphic tool (the “radar graph”) usable for both formative and summative assessment. Using unique, observable behaviors to evaluate levels of competency on the Dreyfus scale, we assessed resident performance in 6 learning sites within our residency. Data are represented on a radar graph, which residents and faculty used to recognize both strengths and areas for growth to guide educational planning for the individual learner.

Results

Initial data show that the radar graphs have construct validity because the development process accurately reflects the desired construct, assessors were adequately trained, and the radar graphs demonstrated resident growth over time. A form completion rate of 90% for >1500 disseminated assessments suggests the feasibility of our process.

Conclusions

The radar graph is a promising tool for use in resident feedback and competency assessment. Further research is needed to determine the full utility of the radar graphs, including a better understanding of the tool's reliability and construct validity.
Results From a Transitional-Year Program Director Survey: Identifying Crucial Issues and Concerns
Authors: Craig Steven R. , Smith Hayden L. , Short Matthew W.
Published: July 2013

Background

Transitional Year (TY) programs meet an important need by preparing residents for specialties that accept individuals after an initial preparatory year. To our knowledge, no surveys to date have been conducted to identify attributes of TY programs and concerns of TY program directors.

Purpose

The purpose of this study was to review TY program characteristics and identify critical issues and concerns of TY program directors (TYPDs).

Methods

A web-based, 22-question survey was sent to all 114 TYPDs of programs accredited by the Accreditation Council for Graduate Medical Education between January and April 2011. The survey included open-formatted and closed-formatted questions addressing program and institution demographics, program director time, administrative support, satisfaction, and future plans.

Results

The survey response rate was 86%. The median age of TY programs was 28 years, with few new programs. More than 80% of TY programs were conducted at community hospitals and university-affiliated community hospitals. Of the responding TYPDs, 17% had served less than 2 years, and 32% had served 10 years or more. Common sponsoring TY programs included internal medicine (88%), general surgery (42%), family medicine (25%), emergency medicine (24%), and pediatrics (18%). Overall, TYPDs were satisfied with their positions. They expressed concerns about inadequate time to complete duties, salary support, and administrative duties assigned to program coordinators. Forty-nine percent of TYPDs reported they planned to leave the position within the next 5 years.

Conclusions

Our survey provides useful information to assist institutions and the graduate medical education community in meeting the needs of TYPDs and strengthening TY programs.
Field Trips as a Novel Means of Experiential Learning in Ambulatory Pediatrics
Authors: Friedland Allen R. , Rintel-Queller Hayley C. , Unnikrishnan Devi , Paul David A.
Published: July 2013

Background

Parents and caregivers look to pediatric health care providers for guidance on feeding, safety issues, and child-care products for children, but trainees have infrequent first-hand exposure to child products marketed to parents.

Objective

To conduct a pilot study to assess an experiential field trip as a novel method of enhancing medical knowledge in ambulatory pediatric feeding and safety.

Methods

Resident physicians and medical students visited a local children's store, where they took part in an interactive store tour, product discussions, and product demonstrations led by a physician educator. Participants also completed a 20-question pretest and a 20-question posttest related to common ambulatory pediatric feeding and safety issues, based on recent American Academy of Pediatrics (AAP) policy statements and practice guidelines.

Results

Sixty-seven medical students and resident physicians participated in the study. Overall, participants' short-term knowledge significantly increased from 9.9 ± 2.6 to 15.4 ± 2.2 questions correct (P  =  .001), with statistically significant gains (P < .001) on both the feeding and safety sections of the test. There were no differences in improvement based on participant's student or resident status, residency program type, program year, sex, or parental status. Ninety-five percent of the participants believed that their knowledge was enhanced by this approach, and participants uniformly agreed that this field trip was valuable to their pediatric training and that such field trip sessions should continue.

Conclusions

The inclusion of experiential learning through an interactive field trip in the curriculum of medical training was acceptable and feasible and showed short-term improvements in knowledge of AAP safety and feeding concepts.
A Novel Approach to Teaching Placement of a B-Lynch Suture: Description of Technique and Validation of Teaching Model
Authors: Vetere Patrick F. , Wayock Christopher P. , Muscat Jolene , Sicuranza Genevieve
Published: July 2013

Introduction

Postpartum hemorrhage is a major cause of maternal morbidity and mortality throughout the world and uterine atony is the leading cause of postpartum hemorrhage. The B-Lynch brace suture is a fertility-sparing approach to treating intractable uterine atony at the time of cesarean delivery. However, many obstetricians lack confidence to perform this procedure, which they may not have performed during residency. In order to train all residents to perform the B-Lynch brace suture, we developed a realistic model by using a flank steak to imitate a gravid uterus.

Methods

A convenience sample of obstetrics-gynecology faculty and residents at different levels of training at a single large hospital participated in this pilot project. Each physician reported self-perceived understanding of and confidence in performing the B-Lynch procedure before and immediately after practicing the technique using the flank-steak model, via a Likert-type survey (scale 1  =  low, 5  =  high). A Wilcoxon matched-pairs signed rank test was used to compare the before and after responses.

Results

Thirty-four participants completed the flank-steak model training and pretraining/posttraining surveys. The median score (range) for self-perceived understanding was 4 (2–5) and increased to 5 (4–5) (P < .01) after exposure to the training model. The confidence scores rose from 3 (1–5) to 5 (4–5) (P < .01) after training.

Conclusion

The flank-steak model for teaching the B-Lynch suture significantly improved resident and faculty self-perceived understanding of and confidence in performing this procedure, which is otherwise rarely practiced in residency.
Situation-Background-Assessment-Recommendation (SBAR) and Emergency Medicine Residents' Learning of Case Presentation Skills
Authors: Tews Matthew C. , Liu J. Marc , Treat Robert
Published: July 2013

Background

To date, no standardized presentation format is taught to emergency medicine (EM) residents during patient handoffs to consulting or admitting physicians. The Situation-Background-Assessment-Recommendation (SBAR) is a common format that provides a consistent framework to communicate pertinent information.

Objective

The objective of this study was to describe and evaluate the feasibility of using SBAR to teach interphysician communication skills to first-year EM residents to use during patient handoffs.

Methods

An educational study was designed as part of a pilot curriculum to teach first-year EM residents handoff communication skills. A standardized SBAR reporting format was taught during a 1-hour didactic intervention. All residents were evaluated using pretest/posttest simulated cases using a 17-item SBAR checklist initially, and then within 4 months to assess retention of the tool. A survey was distributed to determine resident perceptions of the training and potential clinical utility.

Results

There was a statistically significant improvement from the resident scores on the pretest/posttest of the first case (P  =  .001), but there was no difference between posttest of the first case and pretest of the second case (P  =  .34), suggesting retention of the material. There was a statistically significant improvement from the pretest and posttest scores on the second case (P  =  .001). The survey yielded good reliability for both sessions (Cronbach alpha  =  0.87 and 0.89, respectively), demonstrating statistically significant increases for the perceived quality of training, presentation comfort level, and the use of SBAR (P  =  .001).

Conclusion

SBAR was acceptable to first-year EM residents, with improvements in both the ability to apply SBAR to simulated case presentations and retention at a follow-up session. This format was feasible to use as a training method and was well received by our resident physicians. Future research will be useful in examining the general applicability of the SBAR model for interphysician communications in the clinical environment and residency training programs.
Use of a Structured Template to Facilitate Practice-Based Learning and Improvement Projects
Authors: McClain Elizabeth K. , Babbott Stewart F. , Tsue Terance T. , Girod Douglas A. , Clements Debora , Gilmer Lisa , Persons Diane , Unruh Greg
Published: July 2013

Background

The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to meet and demonstrate outcomes across 6 competencies. Measuring residents' competency in practice-based learning and improvement (PBLI) is particularly challenging.

Purpose

We developed an educational tool to meet ACGME requirements for PBLI. The PBLI template helped programs document quality improvement (QI) projects and supported increased scholarly activity surrounding PBLI learning.

Methods

We reviewed program requirements for 43 residency and fellowship programs and identified specific PBLI requirements for QI activities. We also examined ACGME Program Information Form responses on PBLI core competency questions surrounding QI projects for program sites visited in 2008–2009. Data were integrated by a multidisciplinary committee to develop a peer-protected PBLI template guiding programs through process, documentation, and evaluation of QI projects. All steps were reviewed and approved through our GME Committee structure.

Results

An electronic template, companion checklist, and evaluation form were developed using identified project characteristics to guide programs through the PBLI process and facilitate documentation and evaluation of the process. During a 24 month period, 27 programs have completed PBLI projects, and 15 have reviewed the template with their education committees, but have not initiated projects using the template.

Discussion

The development of the tool generated program leaders' support because the tool enhanced the ability to meet program-specific objectives. The peer-protected status of this document for confidentiality and from discovery has been beneficial for program usage. The document aggregates data on PBLI and QI initiatives, offers opportunities to increase scholarship in QI, and meets the ACGME goal of linking measures to outcomes important to meeting accreditation requirements at the program and institutional level.
Impact of Web-Based Review on Long-Term Retention of Simulation-Acquired Knee and Shoulder Aspiration and Injection Skills
Authors: Preisner Ruth , Jasti Harish , Elnicki Michael , Jeong Kwonho
Published: July 2013

Background

Musculoskeletal problems are the reason for one-quarter of primary care visits. Opportunities for internal medicine residents to perform joint aspirations and injections have declined. Simulation has been shown to improve procedure skills post completion of simulation courses, yet controversy exists about the durability of simulation-acquired skills.

Objective

To investigate whether web-based review preserves residents' joint procedure skills 6 to 30 months after a simulation course.

Methods

Postgraduate year–1 internal medicine residents participated in a simulation-based Joint Aspiration Injection Course consisting of web-based instructional material, guided practice on joint models, and a multiple-choice test. Procedure proficiency was scored by using a 3-component skills checklist. Six to 30 months later, residents who had participated in the simulation were randomly assigned to review or not to review the original web-based instructional material before retesting. The groups were compared by using Wilcoxon rank sum and matched pairs signed rank tests.

Results

Compared to the performance at the end of the simulation course, scores of all 3 procedure components declined (informed consent, 64.7–43.0 versus 30.6–23.8, P < .001; procedure proficiency, 63.4–61.7 versus 46.4–44.3, P < .001; and postprocedure instructions, 58.0–54.1 versus 29.9–29.4, P < .001). However, the review group outperformed the nonreview group on informed consent (shoulder: 37.1 versus 24.6, P  =  .01) and postprocedure instructions (shoulder: 34.0 versus 25.2, P  =  .01; knee: 35.5 versus 24.8, P < .001). Residents who reported doing actual procedures maintained a higher confidence level, compared with those reporting none (6.8–5.1 versus 4.1–3.6, P < .001).

Conclusion

Shoulder and knee simulation-acquired skills declined 6 to 30 months after a simulation course. However, rereview of web-based instructional material improved proficiency in informed consent, shoulder, and postprocedure instructions, shoulder and knee.
An Assessment of Family Medicine Residency Networks in the United States
Authors: White Brett , Carney Patricia A. , Garvin Roger
Published: July 2013

Introduction

Residency networks, comprising groups of residency programs organized as collaborative ventures or consortia, have existed in the United States for more than 30 years. At the same time, there have been no comparative assessments of their structures and functions.

Objectives

We conducted a survey of residency networks to assess their organizational structures and activities.

Methods

We identified 9 residency networks and designed a survey to specifically assess their organizational structures and activities. This survey was sent electronically to network leadership and all respective program directors in each residency network. The survey contained 6 areas of focus: (1) network history and administration; (2) network funding; (3) resource sharing and communication within the network; (4) network activities; (5) research within the network; and (6) strengths and weaknesses of the network.

Results

Of the 9 networks, 5 provided data, with 32 of a possible 51 residency programs (62.8%) responding. Respondents reported predominantly functioning as affiliated networks (76.3%) rather than collaborative ventures or consortia. The networks have a variety of funding streams and share resources.

Conclusions

A major function of residency networks is the sharing of resources, particularly in the area of faculty development, with 97.1% of respondents sharing faculty development resources. In addition, all residency networks were actively involved in research, and they participated in political advocacy and in enhancing the engagement of medical students. Networks have been successful at obtaining grants to support their infrastructure.
Assessing the Utility of Procedural Training for Pediatrics Residents in General Pediatric Practice
Authors: Ben-Isaac Eyal , Keefer Matthew , Thompson Michelle , Wang Vincent J.
Published: July 2013

Background

The Accreditation Council for Graduate Medical Education (ACGME) recommends that residents gain broad procedural competence in pediatrics training. There is little recent information regarding practice patterns after graduation.

Objective

We analyzed reported procedures performed in actual practice by graduates of a general pediatrics residency program.

Methods

We conducted an online survey from April 2007 to April 2011 of graduates of a single pediatrics program from a large children's hospital. Eligible participants completed general pediatrics residency training between 1992 and 2006. Graduates were asked about the adequacy of their training for each procedure, as well as the frequency of commonly performed procedures in their practice. As the primary analysis, procedures were divided into emergent and urgent procedures.

Results

Our response rate was 54% (209 of 387). General pediatricians rarely performed emergent procedures, such as endotracheal intubation, intraosseous line placement, thoracostomy, and thoracentesis. Instead, they more commonly performed urgent procedures, such as laceration repair, fracture or dislocation care, bladder catheterization, foreign body removal, and incision and drainage of simple abscesses. Statistically significant differences existed between emergent and urgent procedures (P < .001).

Conclusions

In a single, large, urban, pediatrics residency, 15 years of graduates who practiced general pediatrics after graduation reported they rarely performed emergent procedures, such as endotracheal intubation, but more often performed urgent procedures, such as laceration repair. These results may have implications for ACGME recommendations regarding the amount and type of procedural training required for general pediatrics residents.
Pilot Program Using Medical Simulation in Clinical Decision-Making Training for Internal Medicine Interns
Authors: Miloslavsky Eli M. , Hayden Emily M. , Currier Paul F. , Mathai Susan K. , Contreras-Valdes Fernando , Gordon James A.
Published: July 2013

Background

The use of high-fidelity medical simulation in cognitive skills training within internal medicine residency programs remains largely unexplored.

Objective

To design a pilot study to introduce clinical decision-making training using simulation into a large internal medicine residency program, explore the practicability of using junior and senior residents as facilitators, and examine the feasibility of using the program to improve interns' clinical skills.

Methods

Interns on outpatient rotations participated in a simulation curriculum on a voluntary basis. The curriculum consisted of 8 cases focusing on acute clinical scenarios encountered on the wards. One-hour sessions were offered twice monthly from August 2010 to February 2011. Internal medicine residents and simulation faculty served as facilitators.

Results

A total of 36 of 75 total interns volunteered to participate in the program, with 42% attending multiple sessions. Of all participants, 88% rated the sessions as “excellent,” 97% felt that the program improved their ability to function as an intern and generate a plan, and 81% reported improvement in differential diagnosis skills.

Conclusions

Simulation training was well received by the learners and improved self-reported clinical skills. Using residents as facilitators, supervised by faculty, was well received by the learners and enabled the implementation of the curriculum in a large training program. Simulation can provide opportunities for deliberate practice, and learners perceive this modality to be effective.
Self Versus External Assessment for Technical Tasks in Surgery: A Narrative Review
Authors: Zevin Boris
Published: July 2013

Background

Self-assessment is an intricate component of continuing professional development and lifelong learning for health professionals. The agreement between self and external assessment for cognitive tasks in health professionals is reported to be poor; however, this topic has not been reviewed for technical tasks in surgery.

Objective

To compare self and external assessment for technical tasks in surgery.

Methods

MEDLINE, ERIC, and Google Scholar databases were searched for data from January 1960 to November 2011. Inclusion criteria were restricted to articles published in English in peer-reviewed journals, which reported on a comparison between self and external assessment for a technical task in a surgical specialty and involved medical students, surgical residents, surgical fellows, or practicing surgeons. Abstracts of identified articles were reviewed and pertinent full-text versions were retrieved. Manual searching of bibliographies for additional studies was performed. Data were extracted in a systematic manner.

Results

From a total of 49 citations, 17 studies (35%) were selected for review. Eight of the 17 studies (47%) reported no agreement, whereas 9 studies (53%) reported an agreement between self and external assessment for technical tasks in surgery. Four studies (24%) reported higher self versus external assessment scores, whereas 3 studies (18%) reported lower self versus external assessment scores. Sixteen studies (94%) focused on retrospective self-assessment and 1 study (6%) focused on predictive self-assessment. Agreement improved with higher levels of participant training; with high-quality, timely, and relevant feedback; and with postprocedure video review.

Conclusions

This review demonstrated mixed results regarding an agreement between self and external assessment scores for technical tasks in surgery. Future investigations should attempt to improve the study design by accounting for differences between men and women, conducting paired and independent mean comparisons of self and external assessments, and ensuring that external assessments are valid and reliable.
A Citation Tracking System to Facilitate Sponsoring Institution Oversight of ACGME-Accredited Programs
Authors: Long Timothy R. , Poe John D. , Zimmerman Richard S. , Rose Steven H.
Published: July 2013

Background

The Accreditation Council for Graduate Medical Education (ACGME) requires the graduate medical education committee and the designated institutional official to ensure that citations for noncompliance with the accreditation standards and institutional trends in citations are reviewed and corrected.

Objective

To describe a citation tracking system (CTS) that uses Microsoft Office Access to efficiently catalogue, monitor, and document resolution of citations.

Innovation

The CTS was implemented in a sponsoring institution with oversight of 133 ACGME-accredited programs. The designated institutional official and the graduate medical education committee review all program letters of notification and enter citations into the CTS. A program-correction plan is required for each citation and is entered into the database. Open citations and action plans are reviewed by the graduate medical education committee and the designated institutional official on a quarterly basis, with decisions ranging from “closing” the citation to approving the action plan in process to requiring a new or modified action plan. Citation categories and subcategories are accessed on the ACGME website and entered into the CTS to identify trends.

Results

All 236 citations received since the 2006 Mayo School of Graduate Medical Education institutional site visit were entered into the CTS. On November 22, 2011, 26 of 236 citations (11%) were in active status with ongoing action plans, and 210 (89%) citations had been resolved and were closed.

Conclusions

The CTS uses commercially available software to ensure citations are monitored and addressed and to simplify analysis of citation trends. The approach requires minimal staff time for data input and updates and can be performed without institutional information technology assistance.
Evaluating Nonphysician Staff Members' Self-Perceived Ability to Provide Multisource Evaluations of Residents
Authors: Nikels Susan Michelle , Guiton Gretchen , Loeb Danielle , Brandenburg Suzanne
Published: July 2013

Background

Multisource evaluations of residents offer valuable feedback, yet there is little evidence on the best way to collect these data from a range of health care professionals.

Objective

This study evaluated nonphysician staff members' ability to assess internal medicine residents' performance and behavior, and explored whether staff members differed in their perceived ability to participate in resident evaluations.

Methods

We distributed an anonymous survey to nurses, medical assistants, and administrative staff at 6 internal medicine residency continuity clinics. Differences between nurses and other staff members' perceived ability to evaluate resident behavior were examined using independent t tests.

Results

The survey response rate was 82% (61 of 74). A total of 55 respondents (90%) reported that it was important for them to evaluate residents. Participants reported being able to evaluate professional behaviors very well (62% [36 of 58] on the domain of respect to staff; 61% [36 of 59] on attire; and 54% [32 of 59] on communication). Individuals without a clinical background reported being uncomfortable evaluating medical knowledge (60%; 24 of 40) and judgment (55%; 22 of 40), whereas nurses reported being more comfortable evaluating these competencies. Respondents reported that the biggest barrier to evaluation was limited contact (86%; 48 of 56), and a significant amount of feedback was given verbally rather than on written evaluations.

Conclusions

Nonphysician staff members agree it is important to evaluate residents, and they are most comfortable providing feedback on professional behaviors. A significant amount of feedback is provided verbally but not necessarily captured in a formal written evaluation process.
Fatigue Optimization Scheduling in Graduate Medical Education: Reducing Fatigue and Improving Patient Safety
Authors: McCormick Frank , Kadzielski John , Evans Brady T. , Landrigan Christopher P. , Herndon James , Rubash Harry
Published: July 2013

Background

Medical error is a major cause of preventable morbidity and mortality. Resident fatigue is likely to be a significant contributor.

Objectives

We calculated and compared predicted fatigue impairment in surgical residents on varying schedules by using the validated Sleep, Activity, Fatigue, and Task Effectiveness model and Fatigue Avoidance Scheduling Tool; we identified specific times of day and rotations during which residents were most affected, instituted countermeasures, and measured the predicted response.

Methods

We compared 4 scheduling patterns: day shift, trauma shift, night shift, and prework hour restriction Q3 call (or every-third-night call). The dependent variables were mean daily effectiveness while at work and the percentage of time residents worked with critical fatigue impairment (defined as an effectiveness score of less than 70 correlated with an increased risk for error and a blood alcohol content of 0.08). Fatigue countermeasures (ie, a 30-minute nap, eliminating 24-hour shifts) were applied to rotations with significant impairment to determine impairment plasticity.

Results

Calculated mean effectiveness scores and percentage of time spent impaired at work were as follows: day shift, 90.3, 0%; trauma shift, 82.0, 7.5%; prework hour restriction Q3 call shift, 80.7, 23%; and night shift, 68.0, 50% (P < .001). Fatigue optimization countermeasures for night shift rotation improved mean daily effectiveness to 87.1 with only 1.9% of time working while impaired (P < .001).

Conclusions

There is a significant potential for fatigue impairment in residents, with work schedule a significant factor. Once targeted, fatigue impairment may be minimized with specific countermeasures. Fatigue optimization tools provide data for targeted scheduling interventions, which reduce fatigue and may mitigate medical error.
Recent Family Medicine Residency Graduates' Perceptions of Resident Duty Hour Restrictions
Authors: Peterson Lars E. , Diaz Vanessa , Dickerson Lori M. , Player Marty S. , Carek Peter J.
Published: July 2013

Background

Resident duty hour limits, new requirements for supervision, and an enhanced focus on patient safety have shown mixed effects on resident quality of life, patient safety, and resident competency. Few studies have assessed how recent graduates feel these changes have affected their education.

Objective

We assessed recent graduates' perceptions about the effects of duty hour and supervision requirements on their education.

Methods

We conducted a cross-sectional survey of graduates from South Carolina Area Health Education Consortium-affiliated family medicine residency programs from 2005 to 2009 by using logistic regression to determine associations between participant characteristics and survey responses.

Results

Graduates (N  =  136) completed the survey with a 51.3% response rate. Nearly all (96%) reported that residency prepared them for their current work hours; 97% reported they felt adequately supervised; 81% worked fewer hours in practice than in residency; 20% believed the limits had restricted their clinical experience; and 3% felt duty hour limits were more important than supervision. Graduates who practiced in a mid-sized communities were more likely to report duty hour limits restricted their clinical experience than individuals practicing in communities of <10 000 (OR  =  6.30; 95% CI, 1.38–28.72).

Conclusions

Most graduates who responded to the survey felt supervision was equally or more important than limits on resident duty hours. However, 20% of respondents felt that the duty hour standards limited their education. The duty hour and supervision requirements challenge educators to ensure quality education.
Nature and Impact of Interruptions on Clinical Workflow of Medical Residents in the Inpatient Setting
Authors: Ly Theresa , Korb-Wells Cameron S. , Sumpton Daniel , Russo Robert R. , Barnsley Les
Published: July 2013

Background

Medical officers (trainees) in their first to third postgraduate years (PGY-1–3s) work in complex, busy environments, performing tasks that require concentration and application of learned skills. There are frequently competing demands, and being paged is among the most common.

Objective

We quantified and described the effect of interruptions that paging created on the clinical workflow of PGY-1–3s during ward duties.

Methods

This prospective study was conducted at 2 teaching hospitals in Sydney, Australia. Medical students were recruited as observers to log interruptions of PGY-1–3s' workflow arising from pages from other members of the hospital team.

Results

Forty-two pairs consisting of a PGY-1–3 trainee and an observer were recruited, with 24 proceeding to data collection. Nursing was the most frequent source of pages (47%); other medical staff accounted for 16% of pages, allied health for 12%, and others for 24% (with pharmacy the most common). Pages commonly involved direct patient care (46%), followed by medication issues (21%). Tasks interrupted by pages encompassed direct patient care (37%), indirect patient care (15%), and documentation (12%). Only 27% of pages were assessed as appropriate and urgent, while 58% were considered appropriate but not urgent, and 16% were not appropriate. Only 38% of pages were judged to be clinically more important than the task they interrupted.

Conclusions

Pages frequently interrupted direct patient care activities for PGY-1–3 trainees, and a significant proportion of pages were identified as either not requiring immediate attention or not appropriate, resulting in potentially avoidable interruptions to clinical workflow. Alternate means of alerting trainees to nonurgent tasks may reduce interruptions and facilitate patient care.
A Narrative Review of Surgical Resident Duty Hour Limits: Where Do We Go From Here?
Authors: Fabricant Peter D. , Dy Christopher J. , Dare David M. , Bostrom Mathias P.
Published: July 2013

Background

Resident duty hour limits have been a point of debate among educators, administrators, and policymakers alike since the Libby Zion case in 1984. Advocates for duty hour limits in the surgical subspecialties cite improvements in patient safety, whereas opponents claim that limiting resident duty hours jeopardizes resident education and preparedness for independent surgical practice.

Methods

Using orthopaedic surgery as an example, we describe the historical context of the implementation of the duty hour standards, provide a review of the literature presenting data that both supports and refutes continued restrictions, and outline suggestions for policy going forward that prioritize patient safety while maintaining an enhanced environment for resident education.

Results

Although patient safety markers have improved in some studies since the implementation of duty hour limits, it is unclear whether this is due to changes in residency training or external factors. The literature is mixed regarding academic performance and trainee readiness during and after residency.

Conclusion

Although excessive duty hours and resident fatigue may have historically contributed to errors in the delivery of patient care, those are certainly not the only concerns. An overall “culture of safety,” which includes pinpointing systematic improvements, identifying potential sources of error, raising performance standards and safety expectations, and implementing multiple layers of protection against medical errors, can continue to augment safety barriers and improve patient care. This can be achieved within a more flexible educational environment that protects resident education and ensures optimal training for the next generation of physicians and surgeons.
Relationship Between Performance on Child and Adolescent Psychiatry In-Training and Certification Examinations
Authors: Juul Dorthea , Sexson Sandra B. , Brooks Beth Ann , Beresin Eugene V. , Bechtold Donald W. , Lang Joan A. , Faulkner Larry R. , Tanguay Peter , Dingle Arden D.
Published: July 2013

Background

Studies across a range of specialties have consistently yielded positive associations between performance on in-training examinations and board certification examinations, supporting the use of the in-training examination as a valuable formative feedback tool for residents and residency programs. That association to date, however, has not been tested in child and adolescent psychiatry residents.

Objective

This is the first study to explore the relationship between performance on the American College of Psychiatrists' Child Psychiatry Resident In-Training Examination (CHILD PRITE) and subsequent performance on the American Board of Psychiatry and Neurology's (ABPN) subspecialty multiple-choice examination (Part I) in child and adolescent psychiatry (CAP).

Methods

Pearson correlation coefficients were used to examine the relationship between performance on the CHILD PRITE and the CAP Part I examination for 342 fellows.

Results

Second-year CAP fellows performed significantly better on the CHILD PRITE than did the first-year fellows. The correlation between the CHILD PRITE total score and the CAP Part I examination total score was .41 (P  =  .01) for first-year CAP fellows; it was .52 (P  =  .01) for second-year CAP fellows.

Conclusions

The significant correlations between scores on the 2 tests show they assess the same achievement domain. This supports the use of the CHILD PRITE as a valid measure of medical knowledge and formative feedback tool in child and adolescent psychiatry.
Training at a Faith-Based Institution Matters for Obstetrics and Gynecology Residents: Results From a Regional Survey
Authors: Guiahi Maryam , Westhoff Carolyn L. , Summers Sondra , Kenton Kimberly
Published: July 2013

Background

Prior data suggest that opportunities in family planning training may be limited during obstetrics and gynecology (Ob-Gyn) residency training, particularly at faith-based institutions with moral and ethical constraints, although this aspect of the Ob-Gyn curriculum has not been formally studied to date.

Objectives

We compared Ob-Gyn residents' self-rated competency and intentions to provide family planning procedures at faith-based versus those of residents at non-faith-based programs.

Methods

We surveyed residents at all 20 Ob-Gyn programs in Illinois, Indiana, Iowa, and Wisconsin from 2008 to 2009. Residents were queried about current skills and future plans to perform family planning procedures. We examined associations based on program and residents' personal characteristics and performed multivariable logistic regression analysis.

Results

A total of 232 of 340 residents (68%) from 17 programs (85%) returned surveys. Seven programs were faith-based. Residents from non-faith-based programs were more likely to be completely satisfied with family planning training (odds ratio [OR]  =  3.4, 95% confidence limit [CI], 1.9–6.2) and to report they “understand and can perform on own” most procedures. Most residents, regardless of program type, planned to provide all surveyed family planning services.

Conclusions

Despite similar intentions to provide family planning procedures after graduation, residents at faith-based training programs were less satisfied with their family planning training and rate their ability to perform family planning services lower than residents at non-faith-based training programs.
Brief Educational Intervention Improves Content of Intern Handovers
Authors: Shaughnessy Erin E. , Ginsbach Kimberly , Groeschl Nicole , Bragg Dawn , Weisgerber Michael
Published: July 2013

Background

The Accreditation Council for Graduate Medical Education requires residency programs to ensure safe patient handovers and to document resident competency in handover communication, yet there are few evidence-based curricula teaching resident handover skills.

Objective

We assessed the immediate and sustained impact of a brief educational intervention on pediatrics intern handover skills.

Methods

Interns at a freestanding children's hospital participated in an intervention that included a 1-hour educational workshop on components of high-quality handovers, as well as implementation of a standardized handover format. The format, SAFETIPS, includes patient information, current diagnosis and assessment, patient acuity, a focused plan, a baseline exam, a to-do list, anticipatory guidance, and potential pointers and pitfalls. Important communication behaviors, such as paraphrasing key information, were addressed. Quality of intern handovers was evaluated using a simulated encounter 2 weeks before, 2 weeks after, and 7 months after the workshop. Two trained, blinded, independent observers scored the videotaped encounters.

Results

All 27 interns rotating at the Children's Hospital consented to participate in the study, and 20 attended the workshop. We included all participant data in the analysis, regardless of workshop attendance. Following the intervention, intern reporting of patient acuity improved from 13% to 92% (P < .001), and gains were maintained 7 months later. Rates of key communication behaviors, such as paraphrasing critical information, did not improve.

Conclusions

A brief educational workshop promoting standardized handovers improved the inclusion of essential information during intern handovers, and these improvements were sustained over time. The intervention did not improve key communication behaviors.
A Novel Survey Tool to Assess Pulmonary and Critical Care Fellows' Attitudes Regarding Acquiring Teaching Skills During Fellowship Training
Authors: Richards Jeremy B. , Kelly Emer , Fessler Henry , Roberts David H.
Published: July 2013

Background

Important components of fellowship training include learning teaching skills and career development. Pulmonary and critical care medicine (PCCM) fellows' opinions of the importance of developing teaching skills and interest in careers in medical education have not been previously described, and there are no tools to assess interest in acquiring teaching skills.

Objective

We describe the development and initial psychometric validation of a survey tool to assess trainees' attitudes toward and interest in acquiring teaching skills.

Methods

A survey tool to assess attitudes toward teaching and medical education skills was designed and psychometrically characterized. We then anonymously surveyed fellows in 1 PCCM program to assess their perceptions of and attitudes regarding acquiring teaching skills.

Results

The survey tool demonstrated acceptable psychometric properties. The survey showed that most fellows felt that acquiring teaching skills was “very important,” and nearly half reported being “interested” or “very interested” in pursuing careers as medical educators. However, fellows disagreed with the feedback they received from attending physicians with regard to their teaching abilities (10% disagreed with feedback at the beginning of the year, 36% disagreed at the end of the year; P  =  .03).

Conclusions

Our survey demonstrates acceptable psychometric properties and performance characteristics in a single-site study of PCCM fellows during 1 academic year. Fellows are interested in improving their teaching skills but do not know how to become better teachers. Added research in multiple settings should explore the generalizability of our findings.
Internal Medicine Postgraduate Training and Assessment of Patient Handoff Skills
Authors: Didwania Aashish , Kriss Michael , Cohen Elaine R. , McGaghie William C. , Wayne Diane B.
Published: July 2013

Background

Effective communication during patient care transitions is essential for high-quality patient care.

Objective

The purpose of this study was (1) to objectively assess patient handoff skills of internal medicine residents, and (2) to evaluate correlations between clinical experience and patient handoff skill self-assessment with directly observed skill.

Methods

We studied simulated patient handoffs in postgraduate year (PGY)-1 and PGY-2 residents between July 2011 and September 2011, using a standardized scenario in an observed structured handoff exam (OSHE). Our design was a posttest-only, with nonequivalent groups. Assessment used a previously published checklist for evaluating handoff skills. Residents were asked about clinical experience with patient handoffs and about their self-confidence in performing a patient handoff independently. We evaluated between-group differences on OSHE checklist performance, patient handoff experience, and self-confidence and used multiple regression analyses to assess the association between performance, experience, and confidence.

Results

Forty-seven PGY-1 residents and 38 PGY-2 residents completed the study. Interrater reliability was substantial (intraclass correlation  =  0.68). There was no significant difference in OSHE performance by PGY-1 residents (mean  =  79%, SD  =  4.6) and PGY-2 residents (mean  =  82%; SD  =  7.6; P  =  .07). The PGY-2 residents were significantly more experienced (P < .001) and confident (P < .001) than PGY-1 residents were, yet clinical experience and self-confidence did not significantly predict OSHE performance.

Conclusions

Clinical experience and self-assessment do not predict skills in simulated patient handoffs, and residents with substantial clinical experience still benefit from further skills development.