bluuebunny/crossref_metadata_2025_split huggingface dataset:
Educational Experiences Residents Perceive As Most Helpful for the Acquisition of the ACGME Competencies
Authors: Guerrero Lourdes R. , Baillie Susan , Wimmers Paul , Parker Neil 
Published: July 2013

AbstractBackgroundThe Accreditation Council for Graduate Medical Education (ACGME) requires physicians in training to be educated in 6 competencies considered important for independent medical practice. There is little information about the experiences that residents feel contribute most to the acquisition of the competencies.ObjectiveTo understand how residents perceive their learning of the ACGME competencies and to determine which educational activities were most helpful in acquiring these competencies.MethodA web-based survey created by the graduate medical education office for institutional program monitoring and evaluation was sent to all residents in ACGME-accredited programs at the David Geffen School of Medicine, University of California-Los Angeles, from 2007 to 2010. Residents responded to questions about the adequacy of their learning for each of the 6 competencies and which learning activities were most helpful in competency acquisition.ResultsWe analyzed 1378 responses collected from postgraduate year-1 (PGY-1) to PGY-3 residents in 12 different residency programs, surveyed between 2007 and 2010. The overall response rate varied by year (66%–82%). Most residents (80%–97%) stated that their learning of the 6 ACGME competencies was “adequate.” Patient care activities and observation of attending physicians and peers were listed as the 2 most helpful learning activities for acquiring the 6 competencies.ConclusionOur findings reinforce the importance of learning from role models during patient care activities and the heterogeneity of learning activities needed for acquiring all 6 competencies.
Impact of a Resident-as-Teacher Workshop on Teaching Behavior of Interns and Learning Outcomes of Medical Students
Authors: Hill Andrew G. , Srinivasa Sanket , Hawken Susan J. , Barrow Mark , Farrell Susan E. , Hattie John , Yu Tzu-Chieh 
Published: July 2013

Abstract

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

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

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

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

AbstractIntroductionDevelopment of surgical skills is an integral component of residency education in obstetrics and gynecology.ObjectiveWe report data from a supervised, deliberate, dry lab practice in hysteroscopy for junior obstetrics-gynecology residents, undertaken to evaluate whether simulation training improved hysteroscopy performance to a skill level similar to that of senior residents.MethodsA prospective, comparative, multicenter trial compared Objective Structured Assessment Of Technical Skills (OSATS) performance of 2 groups: 19 postgraduate year (PGY)-1 and PGY-2 and 18 PGY-3 and PGY-4 Ob-Gyn residents. PGY-1 and PGY-2 participants underwent 4 sessions of brief, deliberate, focused training in hysteroscope assembly and operative hysteroscopic polypectomy using uterine models. Subsequently, all participants completed a simulated hysteroscopic polypectomy OSATS, and procedure times and structured assessment scores were compared among groups.ResultsPGY-1 and PGY-2 residents who had completed OSATS training performed at or above the level of untrained PGY-3 and PGY-4 residents. Junior residents had better assembly times and scores, resection scores, and global skills scores (P &lt; .05). Resection times did not differ between groups but differed among institutions.DiscussionBrief, hands-on training sessions, which were task-specific and repetitive facilitated short-term gains in learning operative hysteroscopy and increased the dry lab skill level of junior residents compared to that of senior residents. This curriculum was effectively implemented at 3 institutions and generated comparable results, suggesting generalizability.
A Didactic and Experiential Quality Improvement Curriculum for Psychiatry Residents
Authors: Reardon Claudia L. , Ogrinc Greg , Walaszek Art 
Published: July 2013

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

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

Abstract
We explore the history behind the current structure of graduate medical education funding and the problems with continuing along the current funding path. We then offer suggestions for change that could potentially manage this health care spill. Some of these changes include attracting more students into primary care, aligning federal graduate medical education spending with future workforce needs, and training physicians with skills they will require to practice in systems of the future.