bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of the Hidden Curriculum on Resident Burnout and Cynicism
Authors: Billings Martha E. , Lazarus Michael E. , Wenrich Marjorie , Curtis J. Randall , Engelberg Ruth A.
Published: July 2013

Introduction

Residents learn and participate in care within hospital cultures that may tolerate unprofessional conduct and cynical attitudes, labeled the “hidden curriculum.” We hypothesized that this hidden curriculum may have deleterious effects on residents' professional development and investigated whether witnessing unprofessional behavior during residency was associated with burnout and cynicism.

Methods

We surveyed internal medicine residents at 2 academic centers for 3 years (2008–2010). Hidden curriculum items assessed exposure to unprofessional conduct. We used regression analyses to examine if hidden curriculum scores were associated with cynicism and the Maslach Burnout Inventory depersonalization and emotional exhaustion domain scores.

Results

The response rate was 48% (337 of 708). In the 284 surveys analyzed, 45% of respondents met burnout criteria and had significantly higher hidden curriculum scores (26 versus 19, P < .001) than those not meeting criteria. In cross-sectional analyses, the hidden curriculum score was significantly associated with residents' depersonalization, emotional exhaustion, and cynicism scores. Cynicism scores were also associated with burnout.

Conclusions

Exposure to unprofessional conduct was associated with higher burnout and cynicism scores among internal medicine residents. We also found that cynicism and burnout were significantly associated and may be measures of similar but not necessarily identical responses to the challenges posed by residency. Measuring the hidden curriculum and cynicism may provide direction for educators attempting to reform hospital culture and improve resident well-being.
Resident Scores on a Patient Satisfaction Survey: Evidence for Maintenance of Communication Skills Throughout Residency
Authors: Stewart Emily A. , Marzio Dina Halegoua-De , Guggenheim Douglas E. , Gotto Joanne , Veloski J. Jon , Kane Gregory C.
Published: July 2013

Objective

To examine whether resident communication skills evaluated through patient satisfaction surveys demonstrate evidence of decline through the 3 years of internal medicine residency.

Methods

Data for this study were collected retrospectively from a database of patient satisfaction surveys completed for internal medicine residents at different levels of training. Patient satisfaction was measured with the Aggregated EVGFP (excellent, very good, good, fair, or poor) questionnaire recommended by the American Board of Internal Medicine.

Results

Over a span of 5 years (2005–2009), a total of 768 patient rating forms were completed for 67 residents during their 3 years of residency training. In postgraduate year (PGY)–1, the residents had a mean satisfaction rating of 4.33 ± 0.48 compared to a mean rating of 4.37 ± 0.45 in their PGY-3 year. Analysis of variance indicated no significant difference by PGY level.

Conclusion

Our findings demonstrate that resident communication skills and patient satisfaction do not decline during the 3 years of residency. This is contrary to our hypothesis that patient satisfaction would worsen as residents progressed through training.
Incorporating Evidence into Clinical Teaching: Enhanced Geriatrics Specialty Case-Based Residency Presentations
Authors: Powers James S. , Cahall Molly , Epelbaum Marcia , Habermann Ralf , Rosenstiel Donna , Giuse Nunzia
Published: July 2013

Introduction

Case-based presentations are widely used in medical education and are a preferred education modality to teach about the care of geriatric patients across a range of medical specialties.

Methods

We incorporated evidence-based materials from topical literature syntheses into case-based presentations on the care of geriatric patients for use by specialty residents. These enhanced case-based presentations were used to augment learning and to facilitate detection of additional educational needs for future resident training sessions.

Results

Forty case-based presentations were presented to 11 specialty programs during a 4-year period. The program was popular, and program directors and residents requested additional presentations. Geriatric evidence-based summaries were viewed online 375 times during the course of the project. Geriatric clinical consults increased from an average of 10 consults a year to 141 from 64 different providers during the first year.

Discussion

Case-based presentation, enhanced with evidence-based summaries of research literature generated by information specialists, is a feasible and effective approach to teaching clinical content. These presentations can be used to target geriatrics educational competencies for resident trainees in nongeriatric specialties.
Internal Medicine Residents' Time Study: Paperwork Versus Patient Care
Authors: Alromaihi Dalal , Godfrey Amanda , Dimoski Tina , Gunnels Paul , Scher Eric , Baker-Genaw Kimberly
Published: July 2013

Background

Multiple factors affect residency education, including duty-hour restrictions and documentation requirements for regulatory compliance. We designed a work sampling study to determine the proportion of time residents spend in structured education, direct patient care, indirect patient care that must be completed by a physician, indirect patient care that may be delegated to other health care workers, and personal activities while on an inpatient general practice unit.

Methods

The 3-month study in 2009 involved 14 categorical internal medicine residents who volunteered to use personal digital assistants to self-report their location and primary tasks while on an inpatient general practice unit.

Results

Residents reported spending most of their time at workstations (43%) and less time in patient rooms (20%). By task, residents spent 39% of time on indirect patient care that must be completed by a physician, 31% on structured education, 17% on direct patient care, 9% on indirect patient care that may be delegated to other health care workers, and 4% on personal activities. From these data we estimated that residents spend 34 minutes per patient per day completing indirect patient care tasks compared with 15 minutes per patient per day in direct patient care.

Conclusions

This single-institution time study objectively quantified a current state of how and where internal medicine residents spend their time while on a general practice unit, showing that residents overall spend less time on direct patient care compared with other activities.
Preparing for Oral Scientific and Clinical Vignette Presentations
Authors: Snyder Erin D. , Salanitro Amanda H. , Estrada Carlos , Centor Robert M. , Castiglioni Analia
Published: July 2013

Background

Little is known about how faculty, residents, and fellows practice for oral presentations at academic meetings. We sought to categorize presenters' practice styles and the impact of feedback.

Methods

We surveyed oral presenters at 5 annual academic general internal medicine meetings between 2008 and 2010, using a cross-sectional design. Main measures were frequency and settings of practice, most helpful practice setting, changes made in response to feedback, impact of feedback, and perceived quality of presentation.

Results

The response rate was 63% (333/525 responders). Respondents represented 59 academic medical centers. Presenters reported practicing in a mean ± SD of 2.3 (±1.3) of 5 different settings. Of the 46% of presenters (152/333) who practiced in front of a group of more experienced colleagues, 80% of presenters (122/152) reported it was the most helpful setting. Eighty-one percent of presenters (268/333) practiced alone, and 25% of presenters (82/333) reported practicing alone was the most helpful setting. The mean numbers of change types reported by faculty were fewer than those reported by residents and fellows (mean 2.3 ± 1.8, and 3.1 ± 2.0, respectively; P < .001). Practicing alone was not associated with changes in content (P  =  .30), visual aids (P  =  .12), or delivery style (P  =  .53).

Conclusions

Practicing in front of a group of experienced colleagues was the most helpful setting in which to prepare for an oral academic meeting presentation, but it was not universally utilized. Feedback given at these sessions was more likely to result in changes made to the presentation; however, broader implementation of such sessions may require institutional support.
Comprehensive Training Curricula for Minimally Invasive Surgery
Authors: Palter Vanessa N
Published: July 2013

Background

The unique skill set required for minimally invasive surgery has in part contributed to a certain portion of surgical residency training transitioning from the operating room to the surgical skills laboratory. Simulation lends itself well as a method to shorten the learning curve for minimally invasive surgery by allowing trainees to practice the unique motor skills required for this type of surgery in a safe, structured environment. Although a significant amount of important work has been done to validate simulators as viable systems for teaching technical skills outside the operating room, the next step is to integrate simulation training into a comprehensive curriculum.

Objectives

This narrative review aims to synthesize the evidence and educational theories underlining curricula development for technical skills both in a broad context and specifically as it pertains to minimally invasive surgery.

Findings

The review highlights the critical aspects of simulation training, such as the effective provision of feedback, deliberate practice, training to proficiency, the opportunity to practice at varying levels of difficulty, and the inclusion of both cognitive teaching and hands-on training. In addition, frameworks for integrating simulation training into a comprehensive curriculum are described. Finally, existing curricula on both laparoscopic box trainers and virtual reality simulators are critically evaluated.
Redesign of an Internal Medicine Ward Rotation: Operational Challenges and Outcomes
Authors: Pierce J. Rush , Chang Betty , Rogers Kendall M. , Jernigan Jennifer R. , Fotieo Dana R. , Kang Huining , Leverence Robert R.
Published: July 2013

Introduction

In anticipation of the 2011 ACGME duty hour requirements, we redesigned our internal medicine resident ward experience. Our previous ward structure included a maximum 30-hour duty period for postgraduate year-1 (PGY-1) residents. In the redesigned ward structure, PGY-1 residents had a maximum 18-hour duty period.

Methods

We evaluated resident conference attendance and duty hour violations before and after implementation of our new ward redesign. We administered a satisfaction survey to residents and faculty 6 months after implementation of the new ward redesign.

Results

Before implementation of the ward redesign, 30-hour continuous and 80-h/wk duty violations were each 2/year, and violations of the 10-hour rest between duty periods were 10/year for 74 residents. After implementation of the ward redesign, there were no 30-hour continuous or 80-h/wk duty violations, but violations of the 10-hour rest between duty periods more than doubled (26/year for 75 residents). Duty hours were reported by different mechanisms for the 2 periods. Conference attendance improved. Resident versus faculty satisfaction scores were similar. Both groups judged overall professional satisfaction as slightly worse after implementation.

Conclusion

Our ward rotation redesign eliminated 30-hour continuous and 80-h/wk duty violations as well as improved conference attendance. These benefits occurred at the cost of more faculty hires, decreased resident elective time, and slightly worse postimplementation satisfaction scores.
A Simple, Innovative Surgical-Instruction Tool
Authors: Reiner Irvin J , Castracane V. Daniel
Published: July 2013

In the present report, we demonstrate the utility of a knitting needle as a device to improve the teaching of surgical principals and practice. Although we emphasize obstetric and gynecologic surgery, these techniques can easily be applied to other surgical specialties.
Prospective Comparison of Live Evaluation and Video Review in the Evaluation of Operator Performance in a Pediatric Emergency Airway Simulation
Authors: House Joseph B. , Dooley-Hash Suzanne , Kowalenko Terry , Sikavitsas Athina , Seeyave Desiree M. , Younger John G. , Hamstra Stanley J. , Nypaver Michele M.
Published: July 2013

Introduction

Real-time assessment of operator performance during procedural simulation is a common practice that requires undivided attention by 1 or more reviewers, potentially over many repetitions of the same case.

Objective

To determine whether reviewers display better interrater agreement of procedural competency when observing recorded, rather than live, performance; and to develop an assessment tool for pediatric rapid sequence intubation (pRSI).

Methods

A framework of a previously established Objective Structured Assessment of Technical Skills (OSATS) tool was modified for pRSI. Emergency medicine residents (postgraduate year 1–4) were prospectively enrolled in a pRSI simulation scenario and evaluated by 2 live raters using the modified tool. Sessions were videotaped and reviewed by the same raters at least 4 months later. Raters were blinded to their initial rating. Interrater agreement was determined by using the Krippendorff generalized concordance method.

Results

Overall interrater agreement for live review was 0.75 (95% confidence interval [CI], 0.72–0.78) and for video was 0.79 (95% CI, 0.73–0.82). Live review was significantly superior to video review in only 1 of the OSATS domains (Preparation) and was equivalent in the other domains. Intrarater agreement between the live and video evaluation was very good, greater than 0.75 for all raters, with a mean of 0.81 (95% CI, 0.76–0.85).

Conclusion

The modified OSATS assessment tool demonstrated some evidence of validity in discriminating among levels of resident experience and high interreviewer reliability. With this tool, intrareviewer reliability was high between live and 4-months' delayed video review of the simulated procedure, which supports feasibility of delayed video review in resident assessment.
A Randomized Controlled Trial of the Impact of a Teaching Procedure Service on the Training of Internal Medicine Residents
Authors: Mourad Michelle , Ranji Sumant , Sliwka Diane
Published: July 2013

Introduction

Academic medical centers must provide safe inpatient procedures while balancing resident autonomy and education. We performed a randomized, controlled trial to evaluate the effect of a 2-week hospitalist procedure service (HPS) rotation on interns' self-perceived procedure ability, knowledge, and autonomy versus the standard curriculum.

Methods

We randomly selected 16 of 57 internal medicine interns (28%) to participate in the intervention group rotation, with 29 interns in the control group. All interns were surveyed before the start of residency and at the end of the postgraduate year-1 (PGY-1) and PGY-2 years to evaluate self-reported knowledge and ability to (1) safely perform procedures, (2) supervise procedures, and (3) use bedside ultrasound.

Results

Ninety-four percent of HPS interns (15/16) and 71% of control interns (29/41) completed all surveys. Baseline knowledge and experience did not differ significantly between the groups. The intervention group performed significantly more paracentesis (9 versus 4; P < .001), thoracentesis (6 versus 2; P < .001), and lumbar puncture (4 versus 3; P < .001) procedures than did the control group. After their first year, residents who completed the HPS rotation rated their ability to safely perform and supervise all of the assessed procedures as higher (P < .05 for all procedures) and were more likely to rate self-perceived knowledge as very good or excellent in all surveyed aspects of procedure performance (P < .05).

Discussion

A 2-week hospitalist-supervised procedure service rotation substantially improved residents' experience, confidence, and knowledge in performing bedside procedures early in their training, with this effect sustained through the PGY-2 year. Standardized procedure service rotations are a viable solution for programs seeking to improve their procedure-based education.
Determining Need for Remediation Through Postrotation Evaluations
Authors: Guerrasio Jeannette , Cumbler Ethan , Trosterman Adam , Wald Heidi , Brandenburg Suzanne , Aagaard Eva
Published: July 2013

Introduction

Postrotation evaluations are frequently used by residency program directors for early detection of residents with academic difficulties; however, the accuracy of these evaluations in assessing resident performance has been questioned.

Methods

This retrospective case-control study examines the ability of postrotation evaluation characteristics to predict the need for remediation. We compared the evaluations of 17 residents who were placed on academic warning or probation, from 2000 to 2007, with those for a group of peers matched on sex, postgraduate year (PGY), and entering class.

Results

The presence of an outlier evaluation, the number of words written in the comments section, and the percentage of evaluations with negative or ambiguous comments were all associated with the need for remediation (P  =  .01, P  =  .001, P  =  .002, P  =  < .001, respectively). In contrast, United States Medical Licensing Examination step 1 and step 2 scores, total number of evaluations received, and percentage of positive comments on the evaluations were not associated with the need for remediation (P  =  .06, P  =  .87, P  =  .55, respectively).

Discussion

Despite ambiguous evaluation comments, the length and percentage of ambiguous or negative comments did indicate future need for remediation.

Conclusions

Our study demonstrates that postrotation evaluation characteristics can be used to identify residents as risk. However, larger prospective studies, encompassing multiple institutions, are needed to validate various evaluation methods in measuring resident performance and to accurately predict the need for remediation.
A Novel Comprehensive In-Training Examination Course Can Improve Residency-Wide Scores
Authors: Sharma Rahul , Sperling Jeremy D. , Greenwald Peter W. , Carter Wallace A.
Published: July 2013

Introduction

The annual American Board of Emergency Medicine (ABEM) in-training examination is a tool to assess resident progress and knowledge. We implemented a course at the New York-Presbyterian Emergency Medicine Residency Program to improve ABEM scores and evaluate its effect. Previously, the examination was not emphasized and resident performance was lower than expected.

Methods

As an adjunct to required weekly residency conferences, an intensive 14-week in-training examination preparation program was developed that included lectures, pre-tests, high-yield study sheets, and a remediation program. We compared each residents in-training examination score to the postgraduate year-matched national mean. Scores before and after course implementation were evaluated by repeat measures regression modeling. Residency performance was evaluated by comparing residency average to the national average each year and by tracking ABEM national written examination pass rates.

Results

Following the course's introduction, odds of a resident scoring higher than the national average increased by 3.9 (95% CI 1.9-7.3) and percentage of residents exceeding the national average increased by 37% (95% CI 23%-52%). In the time since the course was started the overall residency mean score has outperformed the national average and the first-time ABEM written examination board pass rate has been 100%.

Conclusion

A multifaceted residency-wide examination curriculum focused around an intensive 14-week course was associated with marked improvement on the in-training examination.
Simulation-Based Education with Mastery Learning Improves Paracentesis Skills
Authors: Barsuk Jeffrey H. , Cohen Elaine R. , Vozenilek John A. , O'Connor Lanty M. , McGaghie William C. , Wayne Diane B.
Published: July 2013

Background

Paracentesis is a commonly performed bedside procedure that has the potential for serious complications. Therefore, simulation-based education for paracentesis is valuable for clinicians.

Objective

To assess internal medicine residents' procedural skills before and after simulation-based mastery learning on a paracentesis simulator.

Methods

A team with expertise in simulation and procedural skills developed and created a high fidelity, ultrasound-compatible paracentesis simulator. Fifty-eight first-year internal medicine residents completed a mastery learning-based intervention using the paracentesis simulator. Residents underwent baseline skill assessment (pretest) using a 25-item checklist. Residents completed a posttest after a 3-hour education session featuring a demonstration of the procedure, deliberate practice, ultrasound training, and feedback. All residents were expected to meet or exceed a minimum passing score (MPS) at posttest, the key feature of mastery learning. We compared pretest and posttest checklist scores to evaluate the effect of the educational intervention. Residents rated the training sessions.

Results

Residents' paracentesis skills improved from an average pretest score of 33.0% (SD  =  15.2%) to 92.7% (SD  =  5.4%) at posttest (P < .001). After the training intervention, all residents met or exceeded the MPS. The training sessions and realism of the simulation were rated highly by learners.

Conclusion

This study demonstrates the ability of a paracentesis simulator to significantly improve procedural competence.
Motivational Interviewing in Health Care: Results of a Brief Training in Endocrinology
Authors: Bean Melanie K. , Biskobing Diane , Francis Gary L. , Wickham Edmond
Published: July 2013

Background

Despite the importance of lifestyle change in disease management and the growing evidence supporting motivational interviewing (MI) as an effective counseling method to promote behavioral change, to date there are few published reports about MI training in graduate medical education.

Objective

The study aimed to pilot the feasibility and effectiveness of a brief MI training intervention for endocrinology fellows and other providers.

Methods

We used a pretest/posttest design to evaluate a brief MI training for 5 endocrinology fellows and 9 other providers. All participants completed subjective assessments of perceived confidence and beliefs about behavioral counseling at pretest and posttest. Objective assessment of MI was conducted using fellows' audiotaped patient encounters, which were coded using a validated tool for adherence to MI before and after the training. Paired t tests examined changes in objective and subjective assessments.

Results

The training intervention was well received and feasible in the endocrinology setting. At posttest, participants reported increased endorsement of the MI spirit and improved confidence in MI skills. Objective assessment revealed relative improvements in MI skills across several domains. However, most domains, as assessed by a validated tool, did not reach competency level after the training intervention.

Conclusions

Although more intensive training may be needed to develop MI competence, the results of our pilot study suggest that brief, targeted MI training has short-term efficacy and is well received by endocrinology fellows and other providers.
Resident Perceptions of Service Versus Clinical Education
Authors: Galvin Shelley L. , Buys Elizabeth
Published: July 2013

Background

The Accreditation Council for Graduate Medical Education states that education needs to have priority over service. There is a potential for residents to have a negative perception of activities termed service.

Objective

To understand how residents of one obstetrics and gynecology program conceptualize service and clinical education in their daily training experiences.

Methods

We conducted a qualitative survey using semistructured interviews with 9 residents in obstetrics and gynecology. Verbatim transcripts underwent phenomenologic analysis for themes and statements exemplifying the essence and nuances of residents' experiences.

Results

The conceptualization of service and clinical education encompassed 6 categories, with some overlap between terms. The category education encompassed (1) tasks and situations with some educational value termed indirect patient care; (2) tasks and situations with high educational values subdivided into direct patient care and teacher-learner interactions; and (3) traditional educational activities, including reflection. Service denoted: (1) tasks and situations with little to no educational value subdivided into indirect and direct patient care categories; (2) tasks and situations with some educational value described as direct patient care; and (3) community service to patients and communities.

Conclusions

Definitions and the relative educational value of service and clinical education experiences overlapped considerably, but they varied by systematic, environmental, and personal factors. Service was used interchangeably to connote negative experiences that interfered with educational goals and positive experiences at the core of the profession's higher calling, the raison d'être of many physicians. The community needs to agree on the definitions of these terms and clarify the meaning of an appropriate balance.
Effect of Audit and Feedback on Improving Handovers: A Nonrandomized Comparative Study
Authors: O'Horo John Charles , Omballi Mohamed , Tran Tony K. , Jordan Jeffrey P. , Baumgardner Dennis J. , Gennis Mark A.
Published: July 2013

Background

High-quality, shift-to-shift handovers by residents are critical to ensuring to patient safety. The 2011 Accreditation Council for Graduate Medical Education duty hour requirements have increased the number of handovers occurring daily, necessitating new approaches to this challenge. Research suggests standardized approaches, electronic systems, and education programs can improve the handover process.

Methods

We conducted a 2-phase, observational study comparing an electronic handover system (experimental) in one clinical setting to a standard card-based system (control) at a second site. Outcome data included an objective assessment of the completeness and accuracy of handovers, and resident assessment of the handover systems. In phase 1, data were recorded at both sites and not shared with residents. In phase 2, data from the experimental system were used to provide standardized feedback to residents on the quality of their handovers.

Results

A total of 3184 individual patient sign-outs were evaluated during the 11-month period. Following introduction of a feedback intervention in the experimental arm, errors were present in only 5.2% of handovers, compared with 16.1% of controls (P < .001), and 67% of the 38 residents responding reported they perceived the experimental system as facilitating better patient care.

Conclusion

Regular, real-time feedback through an electronic handover system can improve the accuracy and completeness of handovers in patient care.
An Incremental Approach to Improving Scholarly Activity
Authors: Penrose Lindsay L. , Yeomans Edward R. , Praderio Carolina , Prien Samuel D.
Published: July 2013

Background

The Accreditation Council for Graduate Medical Education requires scholarly activity for both faculty and residents in obstetrics and gynecology (Ob-Gyn). There is little evidence on the most effective method to train, recruit, and retain research faculty who can mentor resident researchers at small programs.

Innovation

To address this problem, we created the “Baby Steps” program for a small university-based Ob-Gyn program.

Methods

After a thorough assessment of existing resources, a postdoctoral researcher was recruited and coupled with an established researcher to raise the standards of resident research, facilitate and coordinate resident projects, and support clinical faculty participation in research activities. Grant submissions, grants awarded, publications submitted, presentations, and awards were tracked before and after the implementation of the Baby Steps program for faculty and residents.

Results

After 2 years the program has already begun to show an increase in scholarly activity. In a program of 12 residents, 8 made one or more presentations at regional or national meetings within the previous 24 months. Additionally, 8 of 12 clinical faculty members were engaged as mentors in resident research, compared with only 3 in past years. Further, abstract, paper, and grant submissions by faculty increased approximately 25%.

Conclusion

The addition of a mentored postdoctoral researcher was associated with improvements to both resident and faculty research activities. Based on this success, a sister residency program has incorporated the Baby Steps approach into its training.
Influence of Clinical Experience and Productivity on Emergency Medicine Faculty Teaching Scores
Authors: Clyne Brian , Smith Jessica L. , Napoli Anthony M.
Published: July 2013

Background

Commonly cited barriers to effective teaching in emergency medicine include lack of time, competing demands for patient care, and a lack of formal teaching experience. Teaching may be negatively affected by demands for increased clinical productivity, or positively influenced by clinical experience.

Objective

To examine the association between faculty teaching scores and clinical productivity, years of clinical experience, and amount of clinical contact with resident physicians.

Methods

We conducted a retrospective, observational study with existing data on full-time faculty at a high-volume, urban emergency medicine residency training program for academic year 2008–2009. Residents rated faculty on 9 domains of teaching, including willingness to teach, enthusiasm for teaching, medical knowledge, preparation, and communication. Clinical productivity data for relative value units per hour and number of patients per hour, years of clinical experience, and annual clinical hours were obtained from existing databases.

Results

For the 25 core faculty members included in the study, there was no relationship between faculty teaching scores and clinical productivity measures (relative value units per hour: r2  =  0.01, P  =  .96, patients per hour: r2  =  0.00, P  =  .76), or between teaching scores and total clinical hours with residents (r2  =  0.07, P  =  .19). There was a significant negative relationship between years of experience and teaching scores (r2  =  0.27, P < .01).

Conclusions

Our study demonstrated that teaching scores for core emergency medicine faculty did not correlate with clinical productivity or amount of clinical contact with residents. Teaching scores were inversely related to number of years of clinical experience, with more experienced faculty earning the lowest teaching scores. Further study is necessary to determine if there are clinical measures that identify good educators.
A Simulation-Based Curriculum To Address Relational Crises in Medicine
Authors: Peterson Eleanor B. , Porter Melissa B. , Calhoun Aaron W.
Published: July 2013

Introduction

Preparing health care professionals for challenging communication tasks such as delivering bad news to patients and families is an area where a need for improved teaching has been identified.

Objectives

We developed a simulation-based curriculum to enhance the skills of health care professionals, with an emphasis on the communication of difficult or bad news, which we termed relational crises.

Methods

Our approach was based on a review of existing simulation-based curricula, with the addition of unique features, including a learner-focused needs assessment to shape curriculum development, use of 360-degree evaluations, and provision of written feedback. Development and implementation of our curriculum occurred in 3 phases. Phase I involved a multidisciplinary needs assessment, creation of a clinical scenario based on needs assessment results, and training of standardized patients. In Phase II we implemented the curriculum with 36 pediatric and internal medicine-pediatrics residents, 20 nurses, and 1 chaplain. Phase III consisted of the provision of written feedback for learners, created from the 360-degree evaluations compiled from participants, observers, faculty, and standardized patients.

Results

Participants felt the scenarios were realistic (average rating of 4.7 on a 5-point Likert scale) and improved their practice and preparedness for these situations (average rating, 4.75/5 and 4.18/5, respectively). Our curriculum produced a statistically significant change in participants' pre- and postcurriculum self-reported perceptions of skill (2.42/5 vs. 3.23/5, respectively, P < .001) and level of preparedness (2.91/5 vs. 3.72/5, respectively, P < .001).

Discussion

A simulation-based curriculum using standardized patients, learner-identified needs, 360-degree evaluations, and written feedback demonstrated a statistically significant change in participants' self-perceived skills and preparedness for communicating difficult news in pediatrics.
Feedback Based on Observation of Work Rounds Improves Residents' Self-Reported Teaching Skills
Authors: Chandler Daniel , Snydman Laura K. , Rencic Joseph
Published: July 2013

Introduction

Residents provide a significant amount of bedside teaching to medical students and more junior colleagues, but often do not receive feedback that is tailored to this aspect of their professional performance.

Objective

To assess residents' self-reported improvement in teaching skills after feedback based on direct observation of work rounds.

Method

The authors initiated a program of direct observation of residents' teaching during work rounds during the academic year 2007–2008. Eleven interested faculty volunteers, including chief residents, observed teaching on work rounds by 18 second-year residents in internal medicine during 35 total encounters. Within 24 hours, the faculty observers provided individualized feedback to the resident teachers regarding the quantity and quality of their teaching based on the data collected with the Teaching on Work Rounds observation form. At the end of the year, a survey was conducted to assess the residents' receptivity to this program.

Results

Each observation averaged 92 minutes per observer, for 81.5 recorded hours of observations. Eighty percent of the residents felt that they were better teachers because of the feedback they received, and 87% subsequently reported having made conscious changes in their teaching during work rounds.

Discussion

A direct observation program of residents' teaching on work rounds improved residents' interest in teaching while motivating them to make conscious changes in their teaching based on the individualized feedback they received.
Evaluation of a Faculty Development Program Aimed at Increasing Residents' Active Learning in Lectures
Authors: Desselle Bonnie C. , English Robin , Hescock George , Hauser Andrea , Roy Melissa , Yang Tong , Chauvin Sheila W.
Published: July 2013

Background

Active engagement in the learning process is important to enhance learners' knowledge acquisition and retention and the development of their thinking skills. This study evaluated whether a 1-hour faculty development workshop increased the use of active teaching strategies and enhanced residents' active learning and thinking.

Methods

Faculty teaching in a pediatrics residency participated in a 1-hour workshop (intervention) approximately 1 month before a scheduled lecture. Participants' responses to a preworkshop/postworkshop questionnaire targeted self-efficacy (confidence) for facilitating active learning and thinking and providing feedback about workshop quality. Trained observers assessed each lecture (3-month baseline phase and 3-month intervention phase) using an 8-item scale for use of active learning strategies and a 7-item scale for residents' engagement in active learning. Observers also assessed lecturer-resident interactions and the extent to which residents were asked to justify their answers.

Results

Responses to the workshop questionnaire (n  =  32/34; 94%) demonstrated effectiveness and increased confidence. Faculty in the intervention phase demonstrated increased use of interactive teaching strategies for 6 items, with 5 reaching statistical significance (P ≤ .01). Residents' active learning behaviors in lectures were higher in the intervention arm for all 7 items, with 5 reaching statistical significance. Faculty in the intervention group demonstrated increased use of higher-order questioning (P  =  .02) and solicited justifications for answers (P  =  .01).

Conclusion

A 1-hour faculty development program increased faculty use of active learning strategies and residents' engagement in active learning during resident core curriculum lectures.
An Intervention to Improve Ambulatory Care Handoffs at the End of Residency
Authors: Donnelly Michael J. , Clauser Janelle M. , Weissman Neil J.
Published: July 2013

Introduction

The medical literature shows evidence of numerous initiatives to improve inpatient physician handoffs. In contrast, handoffs of ambulatory patients to incoming interns or junior residents at the end of residency are an area of potential concern that has been overlooked.

Objectives

To examine handoffs of high-risk ambulatory patients by outgoing residents to junior colleagues and to compare current practice to a standard handoff process. We hypothesized the intervention would lead to increases in the number and quality of ambulatory care handoffs.

Methods

Fourteen graduating internal medicine and combined internal medicine-pediatrics residents who practiced at an academic continuity clinic were randomized to an intervention or a control group. E-mail instructions were sent asking the intervention group to write a handoff note using the clinic's electronic medical record system. The e-mail included a detailed outline of information to incorporate and highlight features of the electronic medical record that would facilitate the process. The handoff notes of the intervention and control group were independently evaluated and scored for quality using a predetermined point system.

Results

Six of the 7 residents (86%) in the intervention group completed 19 handoff notes; none of the residents in the control group completed handoff notes. Most of the handoffs provided a brief paragraph or 2 of background information on the patient and then focused on issues needing short-term follow-up during the coming months.

Conclusions

The standardized handoff process implemented via simple e-mail instructions increased the number of outpatient handoffs at the completion of residency. Further study with a larger number of residents, identification and removal of barriers to the handoff process, and correlation of handoffs to clinical outcomes are key next steps.
Avatar-Mediated Home Safety Assessments: Piloting a Virtual Objective Structured Clinical Examination Station
Authors: Andrade Allen D. , Cifuentes Pedro , Oliveira Marcelo C. , Anam Ramanakumar , Roos Bernard A. , Ruiz Jorge G.
Published: July 2013

Background

Avatars and virtual worlds offer medical educators new approaches to assess learners' competency in home-safety assessments that are less time-consuming and more flexible than traditional home visits. We sought to evaluate the feasibility and acceptability of implementing an avatar-mediated, 3-dimensional (3-D) home simulation as a virtual objective structured clinical examination station for geriatric medicine fellows.

Methods

We developed a 3-D home simulation in the virtual world Second Life (Linden Lab, San Francisco, CA) containing 50 safety hazards that could affect the safety of an elderly person at home. Eight geriatric medicine fellows participated in a 16-station objective structured clinical examination, with one station assigned to the 15-minute 3-D virtual world simulation, where the fellow's “home visit” was performed by navigating his or her avatar in the virtual world simulation. The fellows were instructed to find the home safety hazards in the simulated environment and then provide specific written recommendations. Two reviewers independently scored the fellows' written findings against an inventory-based checklist.

Results

The geriatric medicine fellows scored a mean of 43% ± SD 9 on the inventory-based checklist. The scoring of the 2 reviewers showed a high interrater reliability (88%). Six of the 8 participants (75%) rated the simulation as “excellent.” Four of the 5 women (80%) and none of the 3 men (20%) participating in the virtual objective structured clinical examination needed navigation assistance in the 3-D virtual house.

Conclusion

The 3-D, avatar-based, virtual geriatric home safety objective structured clinical examination is a practical and acceptable alternative to the traditional home safety visits in an objective structured clinical examination setting.
A Thematic Review of Resident Commentary on Duty Hours and Supervision Regulations
Authors: Drolet Brian C. , Soh Ina Y. , Shultz Paul A. , Fischer Staci A.
Published: July 2013

Background

The implementation on July 1, 2011, of new Accreditation Council for Graduate Medical Education (ACGME) standards for resident supervision and duty hours has prompted considerable debate about the potential positive and negative effects of these changes on patient care and resident education. A recent large-sample study analyzed resident responses to these changes, using a Likert scale response. In this same study, 874 residents also provided free-text comments, which provide added insight into resident perspectives on duty hours and supervision.

Methods

A mixed-methods quantitative and qualitative survey of residents was conducted in August 2010 to assess resident perceptions of the proposed ACGME regulations. Common concerns in the residents' free responses were synthesized and quantified using content analysis, a common method for qualitative research.

Results

A total of 11 617 residents received the survey. Completed surveys were received from 2561 residents (22.0%), with 874 residents (34.1%) providing free-text responses. Most residents (83.0%) expressed unfavorable opinions about the new standards. The most frequently cited concerns included coverage issues, and a negative impact on patient care and education, as well as lack of preparation for senior roles. A smaller portion of residents commented they thought the standards would contribute to improvements in quality of life (36.1%) and patient care (4.9%).

Conclusions

ACGME standards are important for graduate medical education, and their aim is to promote high-quality education and better care to patients in teaching institutions. Yet, many residents are concerned about the day-to-day impact of the 2011 regulations, in particular the 16-hour duty period for interns. Most residents who provided free-text responses had a negative impression of the new ACGME regulations. Residents' resistance to duty hour changes may represent a realization that residents are losing a central role in patient care. The concerns identified in this study demonstrate important issues for administrators and policymakers. Resident ideas and opinions should be considered in future revisions of ACGME requirements.
The Women in Emergency Medicine Mentoring Program: An Innovative Approach to Mentoring
Authors: Welch Julie L. , Jimenez Heather L. , Walthall Jennifer , Allen Sheryl E.
Published: July 2013

Background

Women in medicine report many gender-specific barriers to their career success and satisfaction, including a lack of mentors and role models. The literature calls for innovative strategies to enhance mentorship for women in medicine.

Objective

To describe the content, perceived value, and ongoing achievements of a mentoring program for women in emergency medicine.

Methods

The program offered mentoring for female faculty and residents in an academic emergency medicine department. Volunteers participated in group mentoring sessions using a mosaic of vertical and peer mentoring. Sessions focused on topics specific to women in medicine. An anonymous, electronic survey was sent to women who participated during 2004–2010 to assess the perceived value of the program and to collect qualitative feedback. Preliminary achievements fulfilling the program's goals were tracked.

Results

A total of 46 women (64%) completed the survey. The results showed a positive perceived value of the program (average, 4.65 on a 5-point Likert scale) in providing mentors and role models (4.41), in offering a supportive environment (4.39), in providing discussions pertinent to both personal (4.22) and professional development (4.22), while expanding networking opportunities (4.07). Notable achievements included work on the creation of a family leave policy, establishing lactation space, collaboration on projects, awards, and academic advancement.

Conclusion

This innovative model for mentoring women is perceived as a valuable asset to the academic department and residency. It offers the unique combination of expanding a female mentor pool by recruiting alumni and using a mosaic of vertical and peer mentoring.
Impact of an Anesthesiology Rotation on Subsequent Endotracheal Intubation Success
Authors: Clark Ted R. , Brizendine Edward J. , Milbrandt Joseph C. , Rodgers Kevin G.
Published: July 2013

Background

Endotracheal intubation (ETI) is an essential skill that emergency medicine residents learn throughout their training.

Objective

To evaluate the effect of implementing a postgraduate year (PGY)-1 anesthesiology rotation on ETI success in the emergency department during PGY-2.

Methods

Residents in the study group completed a 4-week PGY-1 anesthesiology rotation. During the first 6 months of PGY-2, we compared ETI performance of the study group with a control group who did not experience a PGY-1 anesthesiology rotation. Data recorded included date, level of training, first- and second-attempt success, rescue devices used, major adverse events, and intubation scenario. A Pearson χ2 test was used to compare first-attempt success, overall success (≤2 attempts), and adverse events rates between the 2 groups.

Results

Overall success rate for the study groups was 95.7% (111 of 116), compared with 94.5% (137 of 145) for the controls (P  =  66). First-attempt success for the study group was 78.4% (91 of 116), compared with 83.4% (121 of 145) for the control group; this was not statistically significant (P  = .30). Observed major and minor adverse events were similar: 19.0% for the study group (22 of 116) versus 24.8% (36 of 145) for the control group (P  = .26).

Conclusions

The addition of an anesthesiology rotation to the PGY-1 curriculum did not have a significant effect on ETI success or the rate of adverse events during the first 6 months of PGY-2. First-attempt overall success and adverse events of our PGY-2 study group were consistent with previously published studies.