bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tracking Residents Through Multiple Residency Programs: A Different Approach for Measuring Residents' Rates of Continuing Graduate Medical Education in ACGME-Accredited Programs
Authors: Byrne Lauren M. , Holt Kathleen D. , Richter Thomas , Miller Rebecca S. , Nasca Thomas J. 
Published: July 2013

Abstract

Background
Increased focus on the number and type of physicians delivering health care in the United States necessitates a better understanding of changes in graduate medical education (GME). Data collected by the Accreditation Council for Graduate Medical Education (ACGME) allow longitudinal tracking of residents, revealing the number and type of residents who continue GME following completion of an initial residency. We examined trends in the percent of graduates pursuing additional clinical education following graduation from ACGME-accredited pipeline specialty programs (specialties leading to initial board certification).

Methods
Using data collected annually by the ACGME, we tracked residents graduating from ACGME-accredited pipeline specialty programs between academic year (AY) 2002–2003 and AY 2006–2007 and those pursuing additional ACGME-accredited training within 2 years. We examined changes in the number of graduates and the percent of graduates continuing GME by specialty, by type of medical school, and overall.

Results
The number of pipeline specialty graduates increased by 1171 (5.3%) between AY 2002–2003 and AY 2006–2007. During the same period, the number of graduates pursuing additional GME increased by 1059 (16.7%). The overall rate of continuing GME increased each year, from 28.5% (6331/22229) in AY 2002–2003 to 31.6% (7390/23400) in AY 2006–2007. Rates differed by specialty and for US medical school graduates (26.4% [3896/14752] in AY 2002–2003 to 31.6% [4718/14941] in AY 2006–2007) versus international medical graduates (35.2% [2118/6023] to 33.8% [2246/6647]).

Conclusion
The number of graduates and the rate of continuing GME increased from AY 2002–2003 to AY 2006–2007. Our findings show a recent increase in the rate of continued training for US medical school graduates compared to international medical graduates. Our results differ from previously reported rates of subspecialization in the literature. Tracking individual residents through residency and fellowship programs provides a better understanding of residents' pathways to practice.
Pediatric Emergency Medicine Residency Experience: Requirements Versus Reality
Authors: Mittiga Matthew R. , Schwartz Hamilton P. , Iyer Srikant B. , Gonzalez del Rey Javier A. 
Published: July 2013

Abstract

Background
An important expectation of pediatric education is assessing, resuscitating, and stabilizing ill or injured children.

Objective
To determine whether the Accreditation Council for Graduate Medical Education (ACGME) minimum time requirement for emergency and acute illness experience is adequate to achieve the educational objectives set forth for categorical pediatric residents. We hypothesized that despite residents working five 1-month block rotations in a high-volume (95 000 pediatric visits per year) pediatric emergency department (ED), the comprehensive experience outlined by the ACGME would not be satisfied through clinical exposure.

Study Design
This was a retrospective, descriptive study comparing actual resident experience to the standard defined by the ACGME. The emergency medicine experience of 35 categorical pediatric residents was tracked including number of patients evaluated during training and patient discharge diagnoses. The achievability of the ACGME requirement was determined by reporting the percentage of pediatric residents that cared for at least 1 patient from each of the ACGME-required disorder categories.

Results
A total of 11.4% of residents met the ACGME requirement for emergency and acute illness experience in the ED. The median number of patients evaluated by residents during training in the ED was 941. Disorder categories evaluated least frequently included shock, sepsis, diabetic ketoacidosis, coma/altered mental status, cardiopulmonary arrest, burns, and bowel obstruction.

Conclusion
Pediatric residents working in one of the busiest pediatric EDs in the country and working 1 month more than the ACGME-recommended minimum did not achieve the ACGME requirement for emergency and acute illness experience through direct patient care.
Developing Future Faculty: A Program Targeting Internal Medicine Fellows' Teaching Skills
Authors: Rosenbaum Marcy E , Rowat Jane A , Ferguson Kristi J , Spengler Erin , Somai Poonam , Carroll James L , Vogelgesang Scott A 
Published: July 2013

Abstract

Introduction
The increased demand for clinician-educators in academic medicine necessitates additional training in educational skills to prepare potential candidates for these positions. Although many teaching skills training programs for residents exist, there is a lack of reports in the literature evaluating similar programs during fellowship training.

Aim
To describe the implementation and evaluation of a unique program aimed at enhancing educational knowledge and teaching skills for subspecialty medicine fellows and chief residents.

Setting
Fellows as Clinician-Educators (FACE) program is a 1-year program open to fellows (and chief residents) in the Department of Internal Medicine at the University of Iowa.

Program Description
The course involves interactive monthly meetings held throughout the academic year and has provided training to 48 participants across 11 different subspecialty fellowships between 2004 and 2009.

Program Evaluation
FACE participants completed a 3-station Objective Structured Teaching Examination using standardized learners, which assessed participants' skills in giving feedback, outpatient precepting, and giving a mini-lecture. Based on reviews of station performance by 2 independent raters, fellows demonstrated statistically significant improvement on overall scores for 2 of the 3 cases. Participants self-assessed their knowledge and teaching skills prior to starting and after completing the program. Analyses of participants' retrospective preassessments and postassessments showed improved perceptions of competence after training.

Conclusion
The FACE program is a well-received intervention that objectively demonstrates improvement in participants' teaching skills. It offers a model approach to meeting important training skills needs of subspecialty medicine fellows and chief residents in a resource-effective manner.
Improving Care in a Resident Practice for Patients With Diabetes
Authors: Salem James K. , Jones Ronald R. , Sweet David B. , Hasan Sana , Torregosa-Arcay Hope , Clough Lynn 
Published: July 2013

Abstract

Background
Curricular redesign and introduction of the Chronic Care Model in our residency clinic during 2005–2007 achieved limited success in glycemic (glycated hemoglobin level [A1c]), lipid (low-density lipoprotein fraction [LDL]), and blood pressure (BP) control for patients with diabetes.

Intervention
Beginning in January 2008, ancillary staff performed previsit, protocol-driven reviews of medical records of patients with diabetes to identify those not at A1c, LDL, and BP goals; inserted electronic prompts into the records regarding deficiencies; and obtained samples for A1c or lipid panel when needed. Faculty feedback regarding resident-specific panel reviews was added in May 2008, and point-of-care A1c testing was implemented in February 2009.

Methods
We conducted a 2-year retrospective study of all patients at our facility with diabetes mellitus, who had at least 1 visit during January to June 2008 (baseline) and 1 visit during July to December 2009 (follow-up). Measures included the most current A1c, LDL, and BP results. Paired outcome results were compared using the McNemar χ2 test.

Results
A total of 522 patients with diabetes mellitus were seen during the baseline and follow-up periods, and 456 patients (87.4%) had paired A1c results, with A1c &lt; 7.0% for 138 of 456 patients (30.3%) at baseline and 166 of 456 patients (36.4%) at follow-up (P  =  .011). For LDL, 460 patients (88.1%) had paired results, with LDL &lt; 100 mg/dL for 225 of 460 patients (48.9%) at baseline and 262 of 460 patients (57.0%) at follow-up (P  =  .004). A total of 513 patients (98.3%) had paired BP results in which the BP &lt; 130/80 mm Hg for 124 of 513 patients (24.2%) at baseline and for 188 of 513 patients (36.6%) at follow-up (P &lt; .001). There were 421 patients (80.7%) with paired results for all 3 measures, with 17 of 421 patients (4.0%) at goal at baseline and 41 of 421 patients (9.7%) at goal at follow-up (P  =  .001).

Conclusion
The interventions resulted in statistically significant improvements in the proportion of patients with diabetes who attained goal for A1c, LDL, and BP levels. Our redesign elements may be useful in enhancing resident education and in improving patient care.
Medico-Legal Education: A Pilot Curriculum to Fill the Identified Knowledge Gap
Authors: Evans Adele , Refrow-Rutala Donna 
Published: July 2013

Abstract

Purpose
We sought to determine if a medico-legal educational curriculum designed to increase physicians' familiarity with the legal system in a nonthreatening environment—a didactic and interactive educational seminar—would positively influence learners' knowledge base and self-awareness.

Methods
Because neither the Accreditation Council for Graduate Medical Education nor its Residency Review Committees specifically addresses medico-legal liability education, we designed a 2-day intensive medico-legal educational curriculum and piloted it in 2007 and 2008 at a large academic tertiary-referral medical center. Postcurriculum evaluations and precurriculum and postcurriculum testing were used to identify areas of common and/or persisting knowledge deficit.

Results
A total of 50 graduating residents, fellows, and community practitioners participated in the course. Common areas of knowledge deficit were “privilege,” “discovery,” statutes of limitations, and basic legal procedure. Discordance in physician interpretation of patient perspective and misunderstanding among physicians of the impact of the legal suit were evident.

Conclusions
Concentrated legal education at selected times during medical training may support physicians' motivations to improve the assurance of quality and continuity of care. We continue to revise the curriculum to address issues of lecturer style, lecture content, and overall attitudinal values related to clinical practice, legal education, long-term impact on practice patterns, job satisfaction and its effect on attention to quality and continuity-of-care issues, and health care provider attitudes about the provider's role within the legal system and the community. We plan to conduct follow-up of participants to assess retention and subsequent use of this knowledge.
Leadership Development for Program Directors
Authors: Bing-You Robert , Wiltshire Whitney , Skolfield Jenny 
Published: July 2013

AbstractBackgroundResidency program directors have increasingly challenging roles, but they may not be receiving adequate leadership development.ObjectiveTo assess and facilitate program directors' leadership self-awareness and development at a workshop retreat.MethodsAt our annual program director retreat, program directors and associate program directors from a variety of specialties completed the Thomas-Kilmann Conflict Mode Instrument (TKI), which evaluates an individual's behavior in conflict situations, and the Hersey-Blanchard Situational Leadership (HBSL) model, which measures individuals' preferred leadership style in working with followers. Participants received their results during the retreat and discussed their leadership style results in the context of conflict situations experienced in the past. An online survey was distributed 3 weeks after the retreat to assess participant satisfaction and to determine whether participants would make changes to their leadership styles.ResultsSeventeen program directors attended the retreat and completed the tools. On the TKI, 47% preferred the Compromising mode for handling conflict, while 18% preferred either the Avoiding or Accommodating modes. On the HBSL, 71% of program directors preferred a Coaching leadership style. Ninety-one percent of postretreat-survey respondents found the leadership tools helpful and also thought they had a better awareness of their conflict mode and leadership style preferences. Eighty-two percent committed to a change in their leadership behaviors in the 6 months following the retreat.ConclusionsLeadership tools may be beneficial for promoting the professional development of program directors. The TKI and HBSL can be used within a local retreat or workshop as we describe to facilitate positive leadership-behavior changes.
Behavioral Evaluations of Anesthesiology Residents and Overuse of the First-Person Pronoun in Personal Statements
Authors: Badal John J. , Jacobsen Wayne K. , Holt Bradley W. 
Published: July 2013

Abstract

Background
The admissions process for residency encompasses numerous objective and subjective measurements by which an applicant is evaluated. The personal interview and clinical evaluations are widely considered the most reliable method to identify unwanted behavioral characteristics. However, the role of a personal statement is less clear. There are reports of residency programs attempting to identify selfish or egocentric behavioral traits by counting the frequency of the first-person pronoun “I” in personal statements. The purpose of this study is to define the relationship between anesthesiology resident evaluations and the frequency of the first-person pronoun within their personal statements.

Methods
Resident evaluations of 48 anesthesiology graduates were collected for 5 competencies. The iScore was calculated by determining the frequency of “I” in relation to total word count.

Results
Correlation analysis between iScore and the 5 evaluation categories showed no significant relationship.

Conclusion
When examining the relationship between resident evaluations and iScore, the lack of significant correlation makes it difficult to predict resident performance based on “I” counts. This may be because the personal statement is a thoughtfully developed document that undergoes extensive editing, which may suppress or minimize writing styles that suggest the presence of unwanted behavioral traits. Further examination of personal statements with a larger sample size and data from other institutions and specialties are needed.
An Interdisciplinary Infection Control Education Intervention: Necessary But Not Sufficient
Authors: P. Wagner Dianne , J. Parker Carol , E. Mavis Brian , Smith Mary Kay 
Published: July 2013

Abstract

Background
Patient care environments are struggling to eradicate health care associated infections and studies of undergraduate and graduate medical trainees have revealed significant gaps in their performance of proper hand hygiene and aseptic technique (HH/AT), suggesting the need for improved curriculum. High-reliability industries have provided a model using standardization of approach and interprofessional training, and both are particularly suited to the teaching and assessment of these life-saving skills. The Infection Control Education project is a grant-funded, multi-institutional pilot launched to improve the teaching and assessment of HH/AT in our community.

Methods
An interprofessional team of leaders and educators from 2 local hospital systems and 3 health colleges developed a 9-component “ICE PACK,” which includes a unanimously endorsed, detailed HH/AT checklist. This teaching and assessment module was delivered to nursing/medical student and postgraduate year 1 resident/nurse intern pairs. Retention of checklist skills was retested 2 to 5 months after participation in the module.

Results
Learner pairs participating in the 2-hour module mastered the HH/AT checklist and rated the experience highly. Retention after several weeks was disappointingly low in 2 of the 3 participant groups.

Conclusions
A community-wide HH/AT checklist was developed and an ICE PACK of materials created that is portable, standardizes the teaching and assessment of HH/AT skills, and is designed for interprofessional pairs of learners. Retention of checklist steps was disappointing in most of participant groups. Multiple, simultaneous strategies for improving compliance with infection control mandates appear necessary.
Numerical Versus Pass/Fail Scoring on the USMLE: What Do Medical Students and Residents Want and Why?
Authors: Lewis Catherine E , Hiatt Jonathan R , Wilkerson LuAnn , Tillou Areti , Parker Neil H , Hines O. Joe 
Published: July 2013

Abstract

Background
Although the primary purpose of the US Medical Licensing Examination (USMLE) is assessment for licensure, USMLE scores often are used for other purposes, more prominently resident selection. The Committee to Evaluate the USMLE Program currently is considering a number of substantial changes, including conversion to pass/fail scoring.

Methods
A survey was administered to third-year (MS3) and fourth-year (MS4) medical students and residents at a single institution to evaluate opinions regarding pass/fail scoring on the USMLE.

Results
Response rate was 59% (n  =  732 of 1249). Reported score distribution for Step 1 was 30% for &lt;220, 38% for 220–240, and 32% for &gt;240, with no difference between MS3s, MS4s, and residents (P  =  .89). Score distribution for Step 2 Clinical Knowledge (CK) was similar. Only 26% of respondents agreed that Step 1 should be pass/fail; 38% agreed with pass/fail scoring for Step 2 CK. Numerical scoring on Step 1 was preferred by respondents who: (1) agreed that the examination gave an accurate estimate of knowledge (odds ratio [OR], 4.23; confidence interval [CI], 2.41–7.43; P &lt; .001); (2) scored &gt;240 (OR, 4.0; CI, 1.92–8.33; P &lt; .001); and (3) felt that acquisition of knowledge might decrease if the examination were pass/fail (OR, 10.15; CI, 3.32–31.02; P &lt; .001). For Step 2 CK, numerical scoring was preferred by respondents who: (1) believed they gained a large amount of knowledge preparing for the examination (OR, 2.63; CI, 1.52–4.76; P &lt; .001); (2) scored &gt;240 (OR, 4.76; CI, 2.86–8.33; P &lt; .001); (3) felt that the amount of knowledge acquired might decrease if it were pass/fail (OR, 28.16; CI, 7.31–108.43; P &lt; .001); and (4) believed their Step 2 CK score was important when applying for residency (OR, 2.37; CI, 1.47–3.84; P &lt; .001).

Conclusions
Students and residents prefer the ongoing use of numerical scoring because they believe that scores are important in residency selection, that residency applicants are advantaged by examination scores, and that scores provide an important impetus to review and solidify medical knowledge.
What Residents Know About Health Care Reform and What We Should Teach Them
Authors: Roberts John L. , Ostapchuk Michael , Miller Karen Hughes , Ziegler Craig H. 
Published: July 2013

Abstract

Purpose
We surveyed residents and fellows at the University of Louisville School of Medicine (N  =  600) to (1) explore their perceptions and knowledge of issues related to health care business and health care reforms, and (2) seek their input on what instructional content concerning health care business and health care reform they would like to receive and what instruction venue they would prefer. We will use the findings to make decisions about curriculum content and delivery.

Methods
All residents were invited to complete a 4-part, web-based survey that included questions on demographics, attitudes, and perceptions; a baseline-knowledge quiz about health care costs; and 2 open-ended questions about what they wanted to learn and how they preferred to be taught.

Results
The survey response rate was 24%. Residents' agreement was stronger for statements relating to the role of physicians as “gatekeepers,” patient-centered care, and the value of learning to work as a team than it was for statements about the benefits of government intervention in health care. International medical graduates, when compared with US medical graduates, had statistically significant differences in perceptions (P ≤ .004) on 3 questions related to government impact on health care. There was a slight decrease in overall knowledge about health care cost issues by residents in later postgraduate years.

Conclusion
Residents are aware of gaps in their knowledge on business aspects of health care and health care reform. Their narrative responses identified coding and billing, legal issues, and comparative health systems as topics of interest, and the best venues for teaching included grand rounds and noon conferences. Residents indicated a preference for brief, highly focused, interactive sessions with knowledgeable guest speakers.
The Pediatrics Milestones: Conceptual Framework, Guiding Principles, and Approach to Development
Authors: Hicks Patricia J. , Schumacher Daniel J. , Benson Bradley J. , Burke Ann E. , Englander Robert , Guralnick Susan , Ludwig Stephen , Carraccio Carol 
Published: July 2013

Abstract

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

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

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

Discussion
The pediatrics milestones take us a step closer to meaningful outcome assessment. Next steps include undertaking rigorous study, making appropriate modifications, and setting performance standards. Our aim is to assist program directors in making more reliable and valid judgments as to whether a resident is a “good doctor” and to provide outcome evidence regarding the program's success in developing doctors.