bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of Human Antiviral Adaptive Immune Responses during Hepatotropic Virus Infection in HLA-Transgenic Human Immune System Mice
Authors: Billerbeck Eva , Horwitz Joshua A. , Labitt Rachael N. , Donovan Bridget M. , Vega Kevin , Budell William C. , Koo Gloria C. , Rice Charles M. , Ploss Alexander
Published: July 2013

Humanized mice have emerged as a promising model to study human immunity in vivo. Although they are susceptible to many pathogens exhibiting an almost exclusive human tropism, human immune responses to infection remain functionally impaired. It has recently been demonstrated that the expression of HLA molecules improves human immunity to lymphotropic virus infections in humanized mice. However, little is known about the extent of functional human immune responses in nonlymphoid tissues, such as in the liver, and the role of HLA expression in this context. Therefore, we analyzed human antiviral immunity in humanized mice during a hepatotropic adenovirus infection. We compared immune responses of conventional humanized NOD SCID IL-2Rγ–deficient (NSG) mice to those of a novel NOD SCID IL-2Rγ–deficient strain transgenic for both HLA-A*0201 and a chimeric HLA-DR*0101 molecule. Using a firefly luciferase–expressing adenovirus and in vivo bioluminescence imaging, we demonstrate a human T cell–dependent partial clearance of adenovirus-infected cells from the liver of HLA-transgenic humanized mice. This correlated with liver infiltration and activation of T cells, as well as the detection of Ag-specific humoral and cellular immune responses. When infected with a hepatitis C virus NS3–expressing adenovirus, HLA-transgenic humanized mice mounted an HLA-A*0201–restricted hepatitis C virus NS3-specific CD8+ T cell response. In conclusion, our study provides evidence for the generation of partial functional antiviral immune responses against a hepatotropic pathogen in humanized HLA-transgenic mice. The adenovirus reporter system used in our study may serve as simple in vivo method to evaluate future strategies for improving human intrahepatic immune responses in humanized mice.
Linezolid Decreases Susceptibility to Secondary Bacterial Pneumonia Postinfluenza Infection in Mice Through its Effects on IFN-γ
Authors: Breslow-Deckman Jessica M. , Mattingly Cynthia M. , Birket Susan E. , Hoskins Samantha N. , Ho Tam N. , Garvy Beth A. , Feola David J.
Published: July 2013

Influenza infection predisposes patients to secondary bacterial pneumonia that contributes significantly to morbidity and mortality. Although this association is well documented, the mechanisms that govern this synergism are poorly understood. A window of hyporesponsiveness following influenza infection has been associated with a substantial increase in local and systemic IFN-γ concentrations. Recent data suggest that the oxazolidinone antibiotic linezolid decreases IFN-γ and TNF-α production in vitro from stimulated PBMCs. We therefore sought to determine whether linezolid would reverse immune hyporesponsiveness after influenza infection in mice through its effects on IFN-γ. In vivo dose-response studies demonstrated that oral linezolid administration sufficiently decreased bronchoalveolar lavage fluid levels of IFN-γ at day 7 postinfluenza infection in a dose-dependent manner. The drug also decreased morbidity as measured by weight loss compared with vehicle-treated controls. When mice were challenged intranasally with Streptococcus pneumoniae 7 d postinfection with influenza, linezolid pretreatment led to decreased IFN-γ and TNF-α production, decreased weight loss, and lower bacterial burdens at 24 h postbacterial infection in comparison with vehicle-treated controls. To determine whether these effects were due to suppression of IFN-γ, linezolid-treated animals were given intranasal instillations of rIFN-γ before challenge with S. pneumoniae. This partially reversed the protective effects observed in the linezolid-treated mice, suggesting that the modulatory effects of linezolid are mediated partially by its ability to blunt IFN-γ production. These results suggest that IFN-γ, and potentially TNF-α, may be useful drug targets for prophylaxis against secondary bacterial pneumonia following influenza infection.
Identification of Paleoproterozoic anorthositic and monzonitic rocks in the vicinity of the Mesoproterozoic Nain Plutonic Suite, Labrador: U-Pb evidence
Authors: Hamilton M A , Ryan A B , Emslie R F , Ermanovics I F
Published: July 2013

Recent mapping along the northeast margin of the Mesoproterozoic Nain Plutonic Suite has revealed an important suite of locally deformed and variably altered anorthositic rocks. Uranium-lead zircon dating of one of these anorthositic rocks reveals a
Paleoproterozoic emplacement age (2112 +5/-4 Ma), broadly equivalent to established ages of nearby 2135-2110 Ma granitic plutons in Nain craton. New Paleoproterozoic emplacement ages (2128 to 2109 Ma) are also reported here for variably foliated dioritic-monzonitic-granitic rocks in the immediate
region, and together with the basic rocks belie the general lithological similarities shared with the younger anorogenic Nain Plutonic Suite plutonic assemblage.
Emplacement of diabase dyke swarms at 2121 ± 1.5 Ma and (crosscutting leucogabbro) at ca. 2045 Ma further substantiate the regional importance of Paleoproterozoic basic magmatism. Leuconoritic and monzodioritic members of the northern Nain Plutonic Suite yield crystallization ages of 1322
± 1 Ma and 1330 ± 1 Ma, respectively. Recognition of significant Paleoproterozoic anorthositic rocks within this dominantly Mesoproterozoic magmatic province imposes important new constraints on massif anorthosite petrogenesis.
U-Pb geochronology of Wijinnedi Lake area, Slave Province, District of Mackenzie, Northwest Territories
Authors: Villeneuve M E , Henderson J B
Published: July 2013

U-Pb ages from the Wijinnedi Lake area of the southwestern Slave Province are presented. A volcaniclastic breccia from the Wijinnedi domain gives an age of 2673.3 ± 1.4 Ma. Granitoids from the Ghost domain have ages between 2605 Ma and 2589 Ma. A sample of
K-feldspar-megacrystic granite that cores the northeasterly trending antiformal structure gives a zircon age of 2598 ± 2 Ma and a monazite age of 2589 ± 2 Ma, identical to the crystallization age of an orthopyroxene-bearing granite. These data provide a maximum age for post-granulite
facies uplift of the Ghost domain. A ca. 2605 Ma age on granodiorite suggests that granulite-facies metamorphism may have lasted at least 15 Ma.
Least deformed trondhjemite from Hinscliffe domain gives a zircon age of 2654 ± 4 Ma and titanite age of approximately 2610 Ma. The difference between the monazite age in the Ghost domain and titanite age in the Hinscliffe domain suggests differential uplift within the region during the latter
stages of Slave Province tectonism.
Toothpick Perforation of the Intestines Presenting as Recurrent Abdominal Pain: Possible Roles of Abdominal Ultrasound and MRI
Authors: Sealock Robert J. , Sabounchi Saman , Graham David Y.
Published: July 2013

We report the case of a middle-aged man admitted for five months of unexplained left lower quadrant pain. He had been hospitalized on two prior occasions and treated with broad spectrum antibiotics. His clinical presentation was suggestive peritoneal irritation with severe, focal pain on abdominal palpation. Computed tomography scans showed non-specific inflammation in the left lower abdomen with adjacent small bowel wall thickening. Upper endoscopy and colonoscopy were unremarkable on prior admission. Given the severity and focality of the patient's recurrent abdominal pain he underwent laparoscopy and was found to have a wooden toothpick perforation of the small bowel thirty centimeters from the ileocecal valve requiring partial small bowel resection. The patient did well post-operatively. On retrospective questioning he may have eaten a cabbage roll or bacon wrapped shrimp pierced with a toothpick weeks before the onset of symptoms. Toothpick perforation should be a consideration in edentulous persons with focal, severe abdominal pain and trans-abdominal ultrasound or MRI may be a better choice for detecting wooden foreign objects.
Effective Encoding for DNA Sequence Visualization Based on Nucleotide's Ring Structure
Authors: Bari A.T.M. Golam , Reaz Rokeya , Islam A.K.M. Tauhidul , Choi Ho-Jin , Jeong Byeong-Soo
Published: July 2013

Effective representation of DNA sequences is one of the important tasks in the study of genome sequences. In this paper, we propose a graphical representation of DNA sequences based on nucleotide ring structure. In the proposed representation, we convert DNA sequences into 16 dinucleotides on the surface of the hexagon so that it can preserve nucleotide's chemical property and positional information. Our approach can provide capability of efficient similarity comparison between DNA sequences and also high comparison accuracy. Furthermore, our approach satisfies uniqueness and no degeneracy of DNA sequences. In the experimental study, we use phylogeny analysis for evolutionary relationship among different species. Extensive performance study shows that the proposed method can give better performance than existing methods in comparison with the degree of similarity.
Rapid Modulation of Aromatase Activity in the Vertebrate Brain
Authors: Charlier Thierry D. , Cornil Charlotte A. , Balthazart Jacques
Published: July 2013

Numerous steroid hormones, including 17β-estradiol (E2), activate rapid and transient cellular, physiological, and behavioral changes in addition to their well-described genomic effects. Aromatase is the key-limiting enzyme in the production of estrogens, and the rapid modulation of this enzymatic activity could produce rapid changes in local E2 concentrations. The mechanisms that might mediate such rapid enzymatic changes are not fully understood but are currently under intense scrutiny. Recent studies in our laboratory indicate that brain aromatase activity is rapidly inhibited by an increase in intracellular calcium concentration resulting from potassium-induced depolarization or from the activation of glutamatergic receptors. Phosphorylating conditions also reduce aromatase activity within minutes, and this inhibition is blocked by the addition of multiple protein kinase inhibitors. This rapid modulation of aromatase activity by phosphorylating conditions is a general mechanism observed in different cell types and tissues derived from a variety of species, including human aromatase expressed in various cell lines. Phosphorylation processes affect aromatase itself and do not involve changes in aromatase protein concentration. The control of aromatase activity by multiple kinases suggests that several amino acids must be concomitantly phosphorylated to modify enzymatic activity but site-directed mutagenesis of several amino acids alone or in combination has not to date revealed the identity of the targeted residue(s). Altogether, the phosphorylation processes affecting aromatase activity provide a new general mechanism by which the concentration of estrogens can be rapidly altered in the brain.
Incorporating Patient- and Family-Centered Care Into Resident Education: Approaches, Benefits, and Challenges
Authors: Philibert Ingrid , Patow Carl , Cichon Jim
Published: July 2013

Purpose

A design conference with participants from accredited programs and institutions was used to explore how the principles of patient- and family-centered care (PFCC) can be implemented in settings where residents learn and participate in care, as well as identify barriers to PFCC and simple strategies for overcoming them.

Approach

In September 2009, the Accreditation Council for Graduate Medical Education (ACGME) held a conference with 74 participants representing a diverse range of educational settings and a group of expert presenters and facilitators. Small group sessions explored the status of PFCC in teaching settings, barriers that need to be overcome in some settings, simple approaches, and the value of a national program and ACGME support.

Findings

Participants shared information on the state of their PFCC initiatives, as well as barriers to implementing PFCC in the learning environment. These emerged in 6 areas: culture, the physical environment, people, time and other constraints, skills and capabilities, and teaching and assessment, as well as simple strategies to help overcome these barriers. Two Ishikawa (Fishbone) diagrams (one for barriers and one for simple strategies) make it possible to select strategies for overcoming particular barriers.

Conclusions

A group of participants with a diversity of approaches to incorporating PFCC into the learning environment agreed that respectful communication with patients/families needs to be learned, supported, and continuously demanded of residents. In addition, for PFCC to be sustainable, it has to be a fundamental expectation for resident learning and attainment of competence. Participants concurred that improving the environment for patients concurrently improves the environment for learners.
Satisfiers and Hygiene Factors: Residents' Perceptions of Strengths and Limitations of Their Learning Environment
Authors: Philibert Ingrid
Published: July 2013

Background

Efforts are underway to enhance learner input into the accreditation of educational programs, including residencies and fellowships.

Objectives

To aggregate the perspectives of residents and fellows from a cross-section of specialties to highlight common dimensions in learners' perceptions of strengths and opportunities for improvement (OFIs) in their program and to assess whether the ACGME Resident Survey captures areas important to residents' perceptions of their learning environment.

Results

The data set included 206 core and 193 subspecialty programs representing a wide range of specialties and subspecialties. Comments on strengths and OFIs addressed most of the items in the Resident Survey, with items not addressed in the survey also not represented in the ACGME requirements. The findings suggest that some program attributes are mentioned only in their absence (hygiene factors), whereas other dimensions (satisfiers), particularly quality and quantity of residents' interactions with faculty, procedural volume, and variety and didactic offerings, are critical to learners' perceptions of the quality of their learning environment. For some strengths, residents indicated their programs exceeded the ACGME standards, and for areas identified as OFIs, comments suggested programs were in compliance, but the residents desired more. Mentioned in this context were opportunities to perform research, access to board preparation courses and career counseling, and availability of new technology, including new patient care modalities.

Conclusions

The findings allow insight into program attributes important to residents' perceptions of their learning environment. Programs may find the results helpful in suggesting areas for improvement in their learning environment.
The Next Accreditation System: Stakeholder Expectations and Dialogue with the Community
Authors: Philibert Ingrid , Nasca Thomas J.
Published: July 2013

In February 2012, in an article in the New England Journal of Medicine,1 the Accreditation Council for Graduate Medical Education (ACGME) provided an initial description and the rationale for the Next Accreditation System (NAS). We follow up with this piece, which reflects on questions about the NAS, as a starting point for a dialogue with the community, and as the first in a series of articles that will describe key attributes of the NAS, offer practical guidance to programs and sponsoring institutions, and solicit stakeholder input. Dialogue with the community will be helpful in answering questions and in allowing the ACGME to clarify and refine certain elements of the NAS. This dialogue needs to be mindful that many details of the NAS are yet to be finalized. In communicating about the NAS, ACGME, thus, must balance a timely response to the community's desire to learn more and the need to have details well established to avoid a need to make changes after details have been released to stakeholders and the public.
Review of Influential Articles in Surgical Education: 2002–2012
Authors: Wohlauer Max V. , George Brian , Lawrence Peter F. , Pugh Carla M. , Van Eaton Erik G. , DaRosa Debra
Published: July 2013

Background

Exploring the trends in surgical education research offers insight into concerns, developments, and questions researchers are exploring that are relevant to teaching and learning in surgical specialties.

Objective

We conducted a review of the surgical education literature published between 2002 and 2012. The purpose was 2-fold: to provide an overview of the most frequently cited articles in the field of surgical education during the last decade and to describe the study designs and themes featured in these articles.

Methods

Articles were identified through Web of Science by using “surgical education” and “English language” as search terms. Using a feature in Web of Science, we tracked the number of citations of any publication. Of the 800 articles produced by the initial search, we initially selected 23 articles with 45 or more citations, and ultimately chose the 20 articles that were most frequently cited for our analysis.

Results

Analysis of the most frequently cited articles published in US journals between the years 2002–2012 identified 7 research themes and presented them in order of frequency with which they appear: use of simulation, issues in student/resident assessment, specialty choice, patient safety, team training, clinical competence assessment, and teaching the clinical sciences, with surgical simulation being the central theme. Researchers primarily used descriptive methods.

Conclusions

Popular themes in surgical education research illuminate the information needs of surgical educators as well as topics of high interest to the surgical community.
The Direct, Indirect, and Intangible Benefits of Graduate Medical Education Programs to Their Sponsoring Institutions and Communities
Authors: Pugno Perry A. , Gillanders William Ross , Kozakowski Stanley M.
Published: July 2013

Declining reimbursement for graduate medical education (GME) as well as increasing hospital competition has placed the cost of GME in the spotlight of institutional administrators. Traditional hospital-generated cost center profit and loss statements fail to accurately reflect the full economic impact of training programs on the institution as well as the larger community. A more complete analysis would take into consideration the direct, indirect, and “intangible” benefits of GME programs. The GME programs usually have a favorable impact on the trainees themselves, the sponsoring institution, the local community, university sponsors and affiliates, and the greater community, and all of these areas need to be considered in the economic analysis. Complete analyses of programs often demonstrate very positive benefits to their sponsoring institutions that would not be recognized on simple cost center profit and loss reports. Studies in the literature that quantify the net economic benefits of GME programs are consistent in their favorable findings.
Out-of-Match Residency Offers: The Possible Extent and Implications of Prematching in Graduate Medical Education
Authors: Wetz Robert V. , Seelig Charles B. , Khoueiry Georges , Weiserbs Kera F.
Published: July 2013

Background

When the data from the National Resident Matching Program (NRMP) are used to analyze trends in medical students' career preferences, positions offered outside the match are omitted. The purpose of the study was to evaluate the extent and nature of out-of-match residency offers.

Methods

We obtained total resident complements and postgraduate year-1 positions offered in 7 specialties in 2007 and compared these with the 2007 NRMP match data. We compared the percentage of positions offered outside the match to “success” in matching United States medical doctors (USMDs) and to the availability of fellowship positions, using the Spearman rank order test (SROT).

Results

A total of 18 030 postgraduate year-1 positions were offered in 9 specialty areas. Of 15 205 positions offered in the match, 54% were taken by USMDs. The percentage of outside-the-match offers was found to vary by specialty, from 7% in obstetrics-gynecology to 23% in internal medicine, and was inversely correlated with the specialty's “success” in matching USMDs (SROT  =  −0.87). The 3 nonprocedural primary care specialties (internal medicine, family medicine, and pediatrics) accounted for 10 091 (46.2%) of the 21 845 total positions offered in the match, with 4401 (43.6%) offered almost entirely to non-USMDs. Another 2467 positions were offered outside the match, resulting in 6868 positions offered to non-USMDs (55% of all primary care positions). In internal medicine, the percentage of outside-the-match offers was significantly and inversely associated with the availability of intrainstitutional fellowship programs (P < .0001). Prematching of independent applicants was significantly higher in primary care than in procedural-lifestyle programs (P < .0001).

Conclusion

The NRMP's match data do not account for positions filled outside the match, a finding that appears to be significant. In 2007, 1 in 5 positions in primary care was offered outside the match.
Night Float Teaching and Learning: Perceptions of Residents and Faculty
Authors: Bricker Dean A. , Markert Ronald J.
Published: July 2013

Background

Most internal medicine residency programs use a night float system to comply with resident duty hour limits. Night float assignments often comprise 7 to 10 weeks of scheduled clinical time during training. Despite this substantial allotment of time to night float, few studies have assessed the adequacy of learning opportunities during these rotations. We designed an exploratory study to assess resident and faculty views about the educational aspects of a typical internal medicine night float system.

Methods

Wright State University Boonshoft School of Medicine internal medicine residents and attending faculty were asked to complete a 25-item voluntary, anonymous survey. A 5-point Likert scale was used to assess perceptions of education during day and night rotations.

Results

The response rate was 52% (85 of 164). Residents rated teaching and learning on day rotations more positively than on night rotations for 17 of 25 (68%) items. Regarding night float, residents rated 14 of 25 items below 3.00; only one item was rated below 3.00 (“…H & P skills observed by attending”) for day rotations. Attending physicians rated day rotations more highly for all 25 survey items. Faculty rated 13 of 25 items below 3.00 for night float and they rated no items below 3.00 for day rotations. Resident and faculty ratings differed significantly for 10 items, with 5 items receiving higher ratings by residents and 5 being rated more positively by faculty.

Conclusion

Despite a substantial allotment of time to night rotations, there appear to be lost teaching and learning opportunities in the current night float system. Modification of the existing format may improve its educational value.
A Multidisciplinary Approach for Teaching Systems-Based Practice to Internal Medicine Residents
Authors: Nabors Christopher , Peterson Stephen J , Weems Roger , Forman Leanne , Mumtaz Arif , Goldberg Randy , Kar Kausik , Borges Joseph A , Doctor Ida , Lubben Orpha , Pherwani Nisha , Frishman William H
Published: July 2013

Background

Rapid growth in the complexity of the health care environment (including monitoring systems for health care quality and patient safety) may result in graduating internists not being adequately prepared for the demands the system places on them. In response, the Residency Review Committee for Internal Medicine created the Educational Innovations Project (EIP) to encourage select residency training programs to develop new strategies and methods to meet changing demands in graduate medical education.

Methods

As part of the EIP, our program created an innovative administrative internship. This multiyear curriculum provides systems-based practice training and consists of a series of rotations that take place during the 3 years of internal medicine residency. Each session involves close interaction with the nonphysician personnel who are instrumental in making our institution a functional and cohesive unit. To assess the potential impact of the rotations, we survey senior residents, recent graduates, and faculty educators. In conjunction with the Performance and Patient Experience departments of the hospital, we track several systems-based practice metrics for residents, including compliance with core health care measures, length of stay, and patient satisfaction.

Results

Residents recognize the need to develop systems-based practice skills, to readily participate in structured curricula designed to enhance such skills, and to provide leadership in organizing and publishing quality improvement initiatives, and upon graduation, they may lament that they did not receive even more vigorous training in these areas.

Conclusion

Although internal medicine residencies continue to improve their training in systems-based practice, our experience suggests that an even greater emphasis on these skills may be warranted.
Smoking Cessation in Family Medicine: Effects of an Area Health Education Center Training Program
Authors: Johns Tracy L. , Lawrence Elizabeth , Martini Leila E. , Dunn Grace E. , Thompson Zachary J. , Zwygart Kira
Published: July 2013

Background and Objectives

Many clinicians have not received adequate training in smoking cessation. We examined the effects of a tobacco training program on clinician behavior, attitudes, knowledge, and comfort related to smoking cessation.

Methods

In a prospective cohort study, family medicine residents and faculty completed a pretest, followed by an educational intervention that encompassed presentations on smoking cessation resources, motivational interviewing, and the neurobiology of addiction and pharmacotherapy. After 3 months, participants completed a postintervention survey. Results were analyzed using chi-square tests to examine the effects of training.

Results

Thirty-three residents and faculty completed the pretraining survey and 25 completed the posttraining survey. Following training, participants were more familiar and comfortable with Public Health Service Clinical Practice Guidelines (P < .0001). No significant differences were found in performance of the 5 As (Ask, Advise, Assess, Assist, and Arrange) or other behaviors, including providing assistance with counseling, cessation plans, resources, or pharmacotherapy. There were no improvements in knowledge of specific intervention plans or attitudes related to identifying and counseling smokers.

Conclusion

A multidisciplinary tobacco training program increases clinician familiarity and comfort with practice guidelines, and may contribute to improving care activities that promote a healthy lifestyle. Future research should explore other interventions that have the potential of changing practice patterns on a larger scale. Future studies should also assess the effect of training programs on patient-oriented outcomes.
Evaluating Professionalism, Practice-Based Learning and Improvement, and Systems-Based Practice: Utilization of a Compliance Form and Correlation with Conflict Styles
Authors: Ogunyemi Dotun , Eno Michelle , Rad Steve , Fong Alex , Alexander Carolyn , Azziz Ricardo
Published: July 2013

Objective

The purpose of this article was to develop and determine the utility of a compliance form in evaluating and teaching the Accreditation Council for Graduate Medical Education competencies of professionalism, practice-based learning and improvement, and systems-based practice.

Methods

In 2006, we introduced a 17-item compliance form in an obstetrics and gynecology residency program. The form prospectively monitored residents on attendance at required activities (5 items), accountability of required obligations (9 items), and completion of assigned projects (3 items). Scores were compared to faculty evaluations of residents, resident status as a contributor or a concerning resident, and to the residents' conflict styles, using the Thomas-Kilmann Conflict MODE Instrument.

Results

Our analysis of 18 residents for academic year 2007–2008 showed a mean (standard error of mean) of 577 (65.3) for postgraduate year (PGY)-1, 692 (42.4) for PGY-2, 535 (23.3) for PGY-3, and 651.6 (37.4) for PGY-4. Non-Hispanic white residents had significantly higher scores on compliance, faculty evaluations on interpersonal and communication skills, and competence in systems-based practice. Contributing residents had significantly higher scores on compliance compared with concerning residents. Senior residents had significantly higher accountability scores compared with junior residents, and junior residents had increased project completion scores. Attendance scores increased and accountability scores decreased significantly between the first and second 6 months of the academic year. There were positive correlations between compliance scores with competing and collaborating conflict styles, and significant negative correlations between compliance with avoiding and accommodating conflict styles.

Conclusions

Maintaining a compliance form allows residents and residency programs to focus on issues that affect performance and facilitate assessment of the ACGME competencies. Postgraduate year, behavior, and conflict styles appear to be associated with compliance. A lack of association with faculty evaluations suggests measurement of different perceptions of residents' behavior.
Initial Experiences in Embedding Core Competency Education in Entry-Level Surgery Residents Through a Nonclinical Rotation
Authors: Kahol Kanav , Huston Carrie , Hamann Jessica , Ferrara John J
Published: July 2013

Background

Health care continues to expand in scope and in complexity. In this changing environment, residents are challenged with understanding its intricacies and the impact it will have on their professional activities and careers.

Aim

Embedding each of the competency elements in residents in a meaningful way remains a challenge for many surgery residency program directors.

Methods

We established a nonclinical rotation to provide surgery postgraduate year-1 (PGY-1) residents with a structured, multifaceted, largely self-directed curriculum into which each of the 6 core competencies are woven. Posttesting strategies were established for most curricular experiences to ensure to the greatest possible extent that each resident will have achieved an acceptable level of understanding of each of the competency areas before being given credit for the rotation.

Results

By uniformly exceeding satisfactory scores on respective objective analyses, residents demonstrated an increased (at least short-term) understanding of each of the assessed competency areas.

Conclusion

Our project sought to address a prior lack of opportunity for our residents to develop a sound foundation for our residents in systems-based practice. Our new rotation addresses systems-based practice in several different learning environments, including emergency medical service ride-along, sentinel event participation, and hospice visits. Several research projects have enhanced the overall learning program. Our experience shows that a rotation dedicated to competency training can provide an innovative and engaging means of teaching residents the value of each element.
Pilot Study Evaluating a Practice-Based Learning and Improvement Curriculum Focusing on the Development of System-Level Quality Improvement Skills
Authors: Tomolo Anne M , Lawrence Renée H , Watts Brook , Augustine Sarah , Aron David C , Singh Mamta K
Published: July 2013

Background

We developed a practice-based learning and improvement (PBLI) curriculum to address important gaps in components of content and experiential learning activities through didactics and participation in systems-level quality improvement projects that focus on making changes in health care processes.

Methods

We evaluated the impact of our curriculum on resident PBLI knowledge, self-efficacy, and application skills. A quasi-experimental design assessed the impact of a curriculum (PBLI quality improvement systems compared with non-PBLI) on internal medicine residents' learning during a 4-week ambulatory block. We measured application skills, self-efficacy, and knowledge by using the Systems Quality Improvement Training and Assessment Tool. Exit evaluations assessed time invested and experiences related to the team projects and suggestions for improving the curriculum.

Results

The 2 groups showed differences in change scores. Relative to the comparison group, residents in the PBLI curriculum demonstrated a significant increase in the belief about their ability to implement a continuous quality improvement project (P  =  .020), comfort level in developing data collection plans (P  =  .010), and total knowledge scores (P < .001), after adjusting for prior PBLI experience. Participants in the PBLI curriculum also demonstrated significant improvement in providing a more complete aim statement for a proposed project after adjusting for prior PBLI experience (P  =  .001). Exit evaluations were completed by 96% of PBLI curriculum participants who reported high satisfaction with team performance.

Conclusion

Residents in our curriculum showed gains in areas fundamental for PBLI competency. The observed improvements were related to fundamental quality improvement knowledge, with limited gain in application skills. This suggests that while heading in the right direction, we need to conceptualize and structure PBLI training in a way that integrates it throughout the residency program and fosters the application of this knowledge and these skills.
Impact of a Teaching Rotation on Residents' Attitudes Toward Teaching: A 5-Year Study
Authors: Le-Bucklin Khanh-Van T. , Hicks Rebecca , Wong Aline
Published: July 2013

Background

Residents play a tremendous role in educating medical students and other residents during their training. Many residency programs have thus instituted formal instruction on teaching. This 5-year study was conducted to quantitatively evaluate the impact of a teaching rotation on residents' attitudes towards teaching.

Methods

Residents participated in a 1-month teaching rotation, which included didactic sessions as well as protected time to practice their teaching skills. Before and after the rotation, residents anonymously filled out surveys regarding their attitudes towards teaching. Data were collected from 73 residents from July 2004 to September 2009. The data were analyzed using a 2-tailed t-test with independent variables and a 1-way ANOVA followed by a posttest.

Results

Four categories showed significant improvement, including feeling prepared to teach (20% increase, P < .0001), having confidence in their teaching ability (16% increase, P < .0001), being aware of their expectations as a teacher (19% increase, P < .0001), and feeling that their anxiety about teaching was at a healthy level (9% increase, P = .0112). There was an increase in the level of enthusiasm, but the P-value did not reach a significant range (P = .121). The level of enthusiasm started high and was significantly higher on the pretest than every other tested category (P < .05).

Conclusions

Residents are enthusiastic about teaching, and their level of enthusiasm remains high following a teaching rotation. Residents feel more prepared to teach, more confident in their teaching ability, more aware of their expectations as a teacher, and less anxious about teaching following a formal teaching rotation.
Feasibility and Reliability of a Multisource Feedback Tool for Emergency Medicine Residents
Authors: Garra Gregory , Wackett Andrew , Thode Henry
Published: July 2013

Background

While the Accreditation Council for Graduate Medical Education recommends multisource feedback (MSF) of resident performance, there is no uniformly accepted MSF tool for emergency medicine (EM) trainees, and the process of obtaining MSF in EM residencies is untested.

Objective

To determine the feasibility of an MSF program and evaluate the intraclass and interclass correlation of a previously reported resident professionalism evaluation, the Humanism Scale (HS).

Methods

To assess 10 third-year EM residents, we distributed an anonymous 9-item modified HS (EM-HS) to emergency department nursing staff, faculty physicians, and patients. The evaluators rated resident performance on a 1 to 9 scale (needs improvement to outstanding). Residents were asked to complete a self-evaluation of performance, using the same scale.

Analysis

Generalizability coefficients (Eρ2) were used to assess the reliability within evaluator classes. The mean score for each of the 9 questions provided by each evaluator class was calculated for each resident. Correlation coefficients were used to evaluate correlation between rater classes for each question on the EM-HS. Eρ2 and correlation values greater than 0.70 were deemed acceptable.

Results

EM-HSs were obtained from 44 nurses and 12 faculty physicians. The residents had an average of 13 evaluations by emergency department patients. Reliability within faculty and nurses was acceptable, with Eρ2 of 0.79 and 0.83, respectively. Interclass reliability was good between faculty and nurses.

Conclusions

An MSF program for EM residents is feasible. Intraclass reliability was acceptable for faculty and nurses. However, reliable feedback from patients requires a larger number of patient evaluations.
Pediatric Resident-as-Teacher Curricula: A National Survey of Existing Programs and Future Needs
Authors: Fromme H. Barrett , Whicker Shari A. , Paik Steve , Konopasek Lyuba , Koestler Jennifer L. , Wood Beverly , Greenberg Larrie
Published: July 2013

Background

We conducted a national survey of US pediatric program directors to explore the current status, content, and teaching methods of Resident-as-Teacher (RAT) curricula. The purposes of the survey were to (1) determine the level and method of evaluation of such curricula, and (2) assess the need for a national curricular resource in this area.

Methods

A survey was sent to US pediatric program directors that asked questions regarding demographics, support, design, development, content, and evaluation of RAT curricula, as well as existing needs and desires for RAT curricular resources.

Results

Sixty-two percent of pediatric program directors completed our survey. Eighty-seven percent have a formal RAT curriculum, but more than 50% allocate 10 hours or less to it during residency. The primary teaching modalities are lectures and workshops. Content areas include feedback, in-patient teaching, communication skills, case-based teaching, role modeling, evaluation, leadership skills, 1-minute preceptors, teaching/learning styles, professionalism, and small-group teaching. Sixty-three percent of programs report evaluating their curricula, but only 27% perceive their program to be very/extremely effective. Nearly all respondents expressed interest in a national RAT curriculum, preferring web-based modules for dissemination.

Conclusions

Despite an Accreditation Council for Graduate Medical Education requirement for a RAT curriculum, some pediatrics programs still lack one, and some consider their program only moderately effective. A wealth of curricular material exists across programs, which could be shared nationally. Establishing a national RAT curriculum would offer programs resources to meet educational mandates and the ability to tailor programs to best fit their own program needs.
Variability in Obtaining Institutional Review Board Approval for Quality Improvement Activities in Residency Programs
Authors: Conforti Lisa N. , Hess Brian J. , Ross Kathryn M. , Lynn Lorna A. , Holmboe Eric S.
Published: July 2013

Introduction

Quality improvement (QI) activities are an important part of residency training. National studies are needed to inform best practices in QI training and experience for residents. The impact of the Institutional Review Board (IRB) process on such studies is not well described.

Methods

This observational study looked at time, length, comfort level, and overall quality of experience for 42 residency training programs in obtaining approval or exemption for a nationally based educational QI study.

Results

For the 42 programs in the study, the time period to IRB approval/exemption was highly variable, ranging from less than 1 week to 56.5 weeks; mean and median time was approximately 18 weeks (SD, 10.8). Greater reported comfort with the IRB process was associated with less time to obtain approval (r  =  −.50; P < .01; 95% CI, −0.70 to −0.23). A more positive overall quality of experience with the IRB process was also associated with less time to obtain IRB approval (r  =  −.60; P < .01; 95% CI, −0.74 to −0.36).

Discussion

The IRB process for residency programs initiating QI studies shows considerable variance that is not explained by attributes of the projects. New strategies are needed to assist and expedite IRB processes for QI research in educational settings and reduce interinstitutional variability and increase comfort level among educators with the IRB process.
A Systematic Review of the Prevalence of Patient Assaults Against Residents
Authors: Kwok Stephanie , Ostermeyer Britta , Coverdale John
Published: July 2013

Objectives

The purpose of this study is to systematically review the literature on the prevalence of patient assaults against residents in all specialties, and to identify curricula that address this issue.

Methods

The authors searched published English-language literature using PubMed and Scopus databases using key terms including “patient,” “assaults,” “threats,” “violence,” “aggression,” and “residents.” A separate search to identify curricula used the same terms in combination with key words including “curriculum,” “didactics,” and “course.” Bibliographies of studies found by electronic searches were also searched manually.

Results

Fifteen studies met the inclusion criteria. Of these, 7 were conducted on psychiatry residents alone, 6 assessed assaults on residents in nonpsychiatric specialties, and 2 reported cross-specialty data. The prevalence of assaults was defined as the percentage of residents who have experienced at least one assault. The prevalence of physical assaults on residents was 38% in surgery, 26% in emergency medicine, 16% to 40% in internal medicine, 5% to 9% in pediatrics, and 25% to 64% in psychiatry. All studies were cross-sectional; none collected data prospectively. Definitions of assault were heterogeneous or not specified. Few of the assaults were reported to clinical supervisors or training directors, and no programs had a formal reporting process. Approximately 21% to 79% of psychiatry residents and 30% of residents in other specialties had received some training on how to manage violent patients. We found no descriptions of formal curricula for managing the possibility of patient violence against residents or for preparing for the aftermath.

Conclusions

Although the data are limited, assaults by patients are commonly experienced by residents in training. There is a paucity of information and curricula that pertain to reducing the prevalence of these incidents and to addressing potential psychologic consequences, especially in nonpsychiatric specialties.
The Impact of the Number of Admissions to the Inpatient Medical Teaching Team on Patient Safety Outcomes
Authors: Averbukh Yelena , Southern William
Published: July 2013

Introduction

The clinical work in academic internal medicine inpatient units is done by teaching teams. To date, few studies have investigated how team workload affects patient safety outcomes.

Objective

We examined the association between the number of patients seen by a teaching team, 30-day readmission, and 60-day mortality.

Methods

In this retrospective observational study we defined each team as “less busy” (total monthly admissions ≤49, the median for all teams) or “more busy” (total monthly admissions >49). We compared patients in both groups' demographic characteristics, comorbidities (Charlson score), severity of illness (the Laboratory-based Acute Physiology Score [LAPS]), and length of stay using t tests, χ2 tests, and rank sum tests, as appropriate. Logistic regression models were constructed to determine whether there was an association between assignment to a busy team and readmission and mortality.

Results

Of 12 119 admissions examined, 6398 (52.8%) were assigned to the less busy teams and 5721 (47.2%) were assigned to busy teams. Mean length of stay was not statistically different between the groups (5.2 vs 5.3 days; P  =  .08). After adjustment for demographic and clinical characteristics (LAPS and Charlson score), care by a busy team was associated with greater 30-day readmission rate (odds ratio, 1.21; 95% confidence interval [CI], 1.10–1.34) but not with increased risk of mortality (odds ratio, 1.05; 95% CI, 0.88–1.27). There was a significant linear association between the number of monthly admissions to teams and the readmission rate.

Conclusions

Admission to a busier teaching team is associated with a 21% increase in the odds of 30-day readmission. Sixty-day mortality was not affected by the number of monthly admissions to the teaching team.
Value Placed on Formal Training in Education by Pediatric Department Chairs and Residency Program Directors
Authors: Turner Teri L. , Ward Mark A. , Palazzi Debra L. , Lorin Martin I.
Published: July 2013

Background

While much is known about how educational leaders at the medical school level (eg, deans) view the importance of formal training in education for medical school teachers, little is known about how leaders at the clinical level (eg, department chairs) view such training. We sought to determine how pediatric department chairs and residency program directors view the value of formal training in education, such as that at a Master of Education (MEd) level, and to estimate the number of clinical pediatric faculty with or pursuing such training.

Methods

A survey designed to assess the value placed on formal training in education and to estimate the number of clinical faculty with or pursuing such training was mailed to pediatric department chair persons and residency program directors at all 131 allopathic medical schools in the United States and Puerto Rico.

Results

Eighty department chairs (61%) responded, and most indicated that when hiring new faculty, they view an applicant with an MEd as having an advantage. Both chairs and residency directors considered an MEd to be advantageous for a residency director by a ranking of 4.5 and 4.2, respectively, on a scale of 1 to 5 (P  =  .008). Of the 80 chairs who responded, 58.8% of respondents reported one or more faculty in their department had or was pursuing an MEd. Of the 72 responding residency directors (55%), 11 respondents (15.3%) indicated that they had an MEd.

Conclusion

More than half the medical school pediatric chairs responding to the survey had one or more clinical faculty with or pursuing an MEd in their departments. Survey results indicated that such training is valued by both department chairs and residency directors. Given the time and expense involved in obtaining an MEd, awareness of these data may be helpful to those considering pursuing, offering, or requiring such training.