bluuebunny/crossref_metadata_2025_split huggingface dataset:
Match Rates Into Higher-Income, Controllable Lifestyle Specialties for Students From Highly Ranked, Research-Based Medical Schools Compared With Other Applicants
Authors: Patel Mitesh S. , Katz Joel T. , Volpp Kevin G. 
Published: July 2013

Abstract

Background
Factors impacting medical student specialty career choice are poorly understood, but may include income potential and lifestyle features such as limited and predictable work hours.

Methods
Data from the National Resident Matching Program and the San Francisco Match were used to examine match rates into higher-income controllable lifestyle (CL), lower-income CL, and noncontrollable lifestyle (NCL) specialties from 2002 to 2007. We studied 3 cohorts: students from highly ranked, research-based medical schools, other US senior medical students, and independent applicants (consisting mostly of graduates from foreign medical schools).

Results
By 2007, 22.5% of students from highly ranked schools matched into a higher-income CL specialty compared with 16.5% of other US seniors and 8.4% of independent applicants. During the study period, students from highly ranked schools increased their match rate in higher-income CL specialties by 7.9%, while all cohorts experienced declines in match rates for NCL specialties. Compared with other US seniors, students from highly ranked schools were more likely to match into higher-income CL specialties (odds ratio [OR], 1.46; 95% confidence interval [CI]: 1.27–1.68), while independent applicants were much less likely to do so (OR, 0.46; 95% CI: 0.42–0.51). Independent applicants had the highest odds (OR, 2.38; 95% CI: 2.25–2.52) of matching into NCL specialties.

Conclusions
All cohorts had declining match rates into NCL specialties from 2002 to 2007. When compared with other US seniors, students from highly ranked schools had the highest odds of matching in higher-income CL specialties, while independent applicants had the highest odds of matching into NCL specialties. These trends are important to consider in light of recent efforts to better balance the physician workforce.
Incoming Interns' Perspectives on the Institute of Medicine Recommendations for Residents' Duty Hours
Authors: Arora Vineet M. , Farnan Jeanne M. , Lypson Monica L. , Anderson R. Andy , Prochaska Meryl H. , Humphrey Holly J. 
Published: July 2013

Abstract

Background
The Accreditation Council for Graduate Medical Education (ACGME) has announced revisions to the resident duty hour standards in light of a 2008 Institute of Medicine report that recommended further limits. Soliciting resident input regarding the future of duty hours is critical to ensure trainee buy-in.

Purpose
To assess incoming intern perceptions of duty hour restrictions at 3 teaching hospitals.

Methods
We administered an anonymous survey to incoming interns during orientation at 3 teaching hospitals affiliated with 2 Midwestern medical schools in 2009. Survey questions assessed interns' perceptions of maximum shift length, days off, ACGME oversight, and preferences for a “fatigued post-call intern who admitted patient” versus “well-rested covering intern who just picked up patient” for various clinical scenarios.

Results
Eighty-six percent (299/346) of interns responded. Although 59% agreed that residents should not work over 16 hours without a break, 50% of interns favored the current limits. The majority (78%) of interns desired ability to exceed shift limit for rare cases or clinical opportunities. Most interns (90%) favored oversight by the ACGME, and 97% preferred a well-rested intern for performing a procedure. Meanwhile, only 48% of interns preferred a well-rested intern for discharging a patient or having an end of life discussion. Interns who favored 16-hour limits were less concerned with negative consequences of duty hour restrictions (handoffs, reduced clinical experience) and more likely to choose the well-rested intern for certain scenarios (odds ratio 2.33, 95% confidence interval 1.42–3.85, P  =  .001).

Conclusions
Incoming intern perceptions on limiting duty hours vary. Many interns desire flexibility to exceed limits for interesting clinical opportunities and favor ACGME oversight. Clinical context matters when interns consider the tradeoffs between fatigue and discontinuity.
A Preliminary Report on Resident Emergency Psychiatry Training From a Survey of Psychiatry Chief Residents
Authors: Bennett Jeffrey I , Dzara Kristina , Mazhar Mir Nadeem , Behere Aniruddh 
Published: July 2013

Abstract

Background
The Accreditation Council for Graduate Medical Education (ACGME) requirements stipulate that psychiatry residents need to be educated in the area of emergency psychiatry. Existing research investigating the current state of this training is limited, and no research to date has assessed whether the ACGME Residency Review Committee requirements for psychiatry residency training are followed by psychiatry residency training programs.

Methods
We administered, to chief resident attendees of a national leadership conference, a 24-item paper survey on the types and amount of emergency psychiatry training provided by their psychiatric residency training programs. Descriptive statistics were used in the analysis.

Results
Of 154 surveys distributed, 111 were returned (72% response rate). Nearly one-third of chief resident respondents indicated that more than 50% of their program's emergency psychiatry training was provided during on-call periods. A minority indicated that they were aware of the ACGME program requirements for emergency psychiatry training. While training in emergency psychiatry occurred in many programs through rotations—different from the on-call period—direct supervision was available during on-call training only about one-third of the time.

Conclusions
The findings suggest that about one-third of psychiatry residency training programs do not adhere to the ACGME standards for emergency psychiatry training. Enhanced knowledge of the ACGME requirements may enhance psychiatry residents' understanding on how their programs are fulfilling the need for more emergency psychiatry training. Alternative settings to the on-call period for emergency psychiatry training are more likely to provide for direct supervision.
Medicine in the 21st Century: Recommended Essential Geriatrics Competencies for Internal Medicine and Family Medicine Residents
Authors: Williams Brent C. , Warshaw Gregg , Fabiny Anne Rebecca , Lundebjerg, MPA Nancy , Medina-Walpole Annette , Sauvigne Karen , Schwartzberg Joanne G. , Leipzig Rosanne M. 
Published: July 2013

Abstract

Background
Physician workforce projections by the Institute of Medicine require enhanced training in geriatrics for all primary care and subspecialty physicians. Defining essential geriatrics competencies for internal medicine and family medicine residents would improve training for primary care and subspecialty physicians. The objectives of this study were to (1) define essential geriatrics competencies common to internal medicine and family medicine residents that build on established national geriatrics competencies for medical students, are feasible within current residency programs, are assessable, and address the Accreditation Council for Graduate Medical Education competencies; and (2) involve key stakeholder organizations in their development and implementation.

Methods
Initial candidate competencies were defined through small group meetings and a survey of more than 100 experts, followed by detailed item review by 26 program directors and residency clinical educators from key professional organizations. Throughout, an 8-member working group made revisions to maintain consistency and compatibility among the competencies. Support and participation by key stakeholder organizations were secured throughout the project.

Results
The process identified 26 competencies in 7 domains: Medication Management; Cognitive, Affective, and Behavioral Health; Complex or Chronic Illness(es) in Older Adults; Palliative and End-of-Life Care; Hospital Patient Safety; Transitions of Care; and Ambulatory Care. The competencies map directly onto the medical student geriatric competencies and the 6 Accreditation Council for Graduate Medical Education Competencies.

Conclusions
Through a consensus-building process that included leadership and members of key stakeholder organizations, a concise set of essential geriatrics competencies for internal medicine and family medicine residencies has been developed. These competencies are well aligned with concerns for residency training raised in a recent Medicare Payment Advisory Commission report to Congress. Work is underway through stakeholder organizations to disseminate and assess the competencies among internal medicine and family medicine residency programs.
Evaluation of a Transition to Practice Program for Neurosurgery Residents: Creating a Safe Transition From Resident to Independent Practitioner
Authors: Lister J. Richard , Friedman William A. , Murad Gregory J. , Dow Jamie , Lombard Gwen J. 
Published: July 2013

Abstract

Background
In 2004, the Department of Neurosurgery at the University of Florida implemented a major curriculum innovation called the Transition to Practice program. This program was established to prepare residents to more safely transition to the role of independent practitioner.

Methods
A qualitative and quantitative evaluation of the program was conducted after its fifth year using online surveys and interviews. Study participants included Transition to Practice graduates, faculty, and current residents.

Results
Of the 26 respondents, 89% of faculty and all graduates were very satisfied with the program. Strengths identified included an independent yet mentored broad operative experience, the development of self-confidence, and a real sense of responsibility for patients. Medical billing and coding instruction and career mentoring were areas of the program that required additional attention.

Conclusion
Overall, this program is meeting the stated objectives and is well received by the graduates and faculty. Based on the results of this evaluation, curricular changes such as instructions in practice management and implementation of a career-mentoring program have occurred. The Transition to Practice program is a unique curricular response to change that other surgical specialties may find useful in addressing the current-day stresses on graduate medical education.
Factors Influencing Choice of Medical Specialty of Preresidency Medical Graduates in Southeastern Nigeria
Authors: Eze Boniface Ikenna , Okoye Onochie Ike , Maduka-Okafor Ferdinand Chinedu , Aguwa Emmanuel Nwabueze 
Published: July 2013

Abstract

Background
This study examined the determinants of specialty choice of preresidency medical graduates in southeastern Nigeria.

Methods
We used a comparative cross-sectional survey of preresidency medical graduates who took the Basic Sciences Examination of the Postgraduate Medical College in Enugu, southeastern Nigeria, in March 2007. Data on participants' demographics and specialty selected, the timing of the decision, and factors in specialty selection were collected using a questionnaire. Data were examined using descriptive and analytical statistics. P &lt; .05 was considered significant.

Results
The survey response rate was 90.8% (287 of 316). The sample included 219 men and 68 women, ranging in age from 24 to 53 years and with a mean age of 33.5 ± 1.1 (SD) years. Career choice was more frequently influenced by personal interest (66.6%), career prospects (9.1%), and appraisal of own skills/aptitudes (5.6%), and it was least affected by altruistic motives (1.7%) and influence of parents/relations (1.7%). The respondents selected specialties at different rates: obstetrics and gynecology (22.6%), surgery (19.6%), pediatrics (16.0%), anesthesiology (3.1%), psychiatry (0.3%), and dentistry (0.0%). Most (97.2%) participants had decided on specialty choice by the end of their fifth (of a total 16 years) postgraduate year. The participants significantly more frequently preferred surgery and pediatrics to other disciplines (P &lt; .002, after Bonferroni correction for multiple comparisons).

Conclusions
Preresidency medical graduates in southeastern Nigeria were influenced by personal interest, career prospects, and personal skills/aptitude in deciding which specialty training to pursue. The most frequently chosen specialties were surgery and pediatrics. These findings have implications for Nigeria's education and health care policy makers.
Development and Preliminary Evaluation of a Practice-Based Learning and Improvement Tool for Assessing Resident Competence and Guiding Curriculum Development
Authors: Lawrence Renée H , Tomolo Anne M 
Published: July 2013

Abstract

Background
Although practice-based learning and improvement (PBLI) is now recognized as a fundamental and necessary skill set, we are still in need of tools that yield specific information about gaps in knowledge and application to help nurture the development of quality improvement (QI) skills in physicians in a proficient and proactive manner. We developed a questionnaire and coding system as an assessment tool to evaluate and provide feedback regarding PBLI self-efficacy, knowledge, and application skills for residency programs and related professional requirements.

Methods
Five nationally recognized QI experts/leaders reviewed and completed our questionnaire. Through an iterative process, a coding system based on identifying key variables needed for ideal responses was developed to score project proposals. The coding system comprised 14 variables related to the QI projects, and an additional 30 variables related to the core knowledge concepts related to PBLI. A total of 86 residents completed the questionnaire, and 2 raters coded their open-ended responses. Interrater reliability was assessed by percentage agreement and Cohen κ for individual variables and Lin concordance correlation for total scores for knowledge and application. Discriminative validity (t test to compare known groups) and coefficient of reproducibility as an indicator of construct validity (item difficulty hierarchy) were also assessed.

Results
Interrater reliability estimates were good (percentage of agreements, above 90%; κ, above 0.4 for most variables; concordances for total scores were R  =  .88 for knowledge and R  =  .98 for application).

Conclusion
Despite the residents' limited range of experiences in the group with prior PBLI exposure, our tool met our goal of differentiating between the 2 groups in our preliminary analyses. Correcting for chance agreement identified some variables that are potentially problematic. Although additional evaluation is needed, our tool may prove helpful and provide detailed information about trainees' progress and the curriculum.
Observational Study Using the Tools of Lean Six Sigma to Improve the Efficiency of the Resident Rounding Process
Authors: Chand David V. 
Published: July 2013

Abstract

Background
Recent focus on resident work hours has challenged residency programs to modify their curricula to meet established duty hour restrictions and fulfill their mission to develop the next generation of clinicians. Simultaneously, health care systems strive to deliver efficient, high-quality care to patients and families. The primary goal of this observational study was to use a data-driven approach to eliminate examples of waste and variation identified in resident rounding using Lean Six Sigma methodology. A secondary goal was to improve the efficiency of the rounding process, as measured by the reduction in nonvalue-added time.

Methods
We used the “DMAIC” methodology: define, measure, analyze, improve, and control. Pediatric and family medicine residents rotating on the pediatric hospitalist team participated in the observation phase. Residents, nurses, hospitalists, and parents of patients completed surveys to gauge their attitudes toward rounds. The Mann-Whitney test was used to test for differences in the median times measured during the preimprovement and postimprovement phases, and the Student t test was used for comparison of survey data.

Results and Discussion
Collaborative, family-centered rounding with elimination of the “prerounding” process, as well as standard work instructions and pacing the process to meet customer demand (takt time), were implemented. Nonvalue-added time per patient was reduced by 64% (P  =  .005). Survey data suggested that team members preferred the collaborative, family-centered approach to the traditional model of rounding.

Conclusions
Lean Six Sigma provides tools, a philosophy, and a structured, data-driven approach to address a problem. In our case this facilitated an effort to adhere to duty hour restrictions while promoting education and quality care. Such approaches will become increasingly useful as health care delivery and education continue to transform.
Interdisciplinary Prenatal Group Visits as a Significant Learning Experience
Authors: McLeod Angela Yerdon , LaClair Cynthia , Kenyon Tina 
Published: July 2013

Abstract

Aim
Group visits offer documented benefit to patients and clinicians. They also provide an excellent venue to teach residents interdisciplinary care and group facilitation skills.

Intervention
Third-year residents received experiential training to provide prenatal care through group visits rather than one-on-one visits.

Study Method
A descriptive study is used to illustrate the effectiveness of various facets of resident skill acquisition and patient-centered prenatal care. Evaluation methods included feedback from patients, team members, learner self-reflection, and observation by a behavioral health clinician.

Summary
Residents collaboratively provide prenatal care in a group model during a 6-month period. Interdisciplinary team members explicitly teach and model biopsychosocial whole-person care and effective communication. This inventive experience has increased resident competency-based skills in facilitation and effective team collaboration as measured through observation. These skills are directly applicable in future primary care medical home practice. Using a group visit model benefits patients and clinicians, and promotes enriching and effective resident education. Our model can easily be implemented in other programs.
A Public Health Approach to Pediatric Residency Education: Responding to Social Determinants of Health
Authors: Kuo Alice A. , Shetgiri Rashmi , Guerrero Alma D. , Barreto Patricia M. , Perez Victor H. , Fond Karen , Slusser Wendelin 
Published: July 2013

AbstractObjectiveTo evaluate the impact of a public health approach to pediatric residency education on learner knowledge, skills, attitudes, beliefs, and career choice.BackgroundIncorporating public health principles into traditional residency education can give pediatricians the population-oriented perspective to address social determinants of health.MethodsThe Community Health and Advocacy Training (CHAT) program is an educational intervention with a public health framework. From 2001–2007, 215 categorical pediatric residents and 37 residents in the CHAT program were evaluated by using an annual survey of community pediatrics exposure, knowledge, attitudes, and beliefs. American Board of Pediatrics (ABP) examination passage rates for both groups were also examined, as was career choice after graduation.ResultsWhile interns in both the categorical and CHAT programs scored similarly on attitudes, beliefs, skills, and knowledge of community pediatrics, the postgraduate level-3 (PL-3) year CHAT residents scored higher in attitudes (P &lt; .001) and skills (P &lt; .05). Exposure to both didactic (P &lt; .05) and practical (P &lt; .001) community pediatrics curricular experiences were higher for CHAT residents than for categorical residents. No significant differences between ABP examination scores were found for the 2 groups, although 100% of CHAT graduates passed on the first try compared to 91% of categorical graduates during this time period. A greater percentage of CHAT graduates (82%) than categorical graduates (53%) reported pursuing careers in primary care.ConclusionWith a public health approach to residency education, residents gain the knowledge, attitudes, and skills to address child health problems from a population perspective. Participation in such a curriculum still resulted in high passage rates on the ABP examination.
Training Gaps for Pediatric Residents Planning a Career in Primary Care: A Qualitative and Quantitative Study
Authors: Rosenberg Adam A , Kamin Carol , Glicken Anita Duhl , Jones M. Douglas 
Published: July 2013

Abstract

Background
Resident training in pediatrics currently entails similar training for all residents in a fragmented curriculum with relatively little attention to the career plans of individual residents.

Objectives
To explore strengths and gaps in training for residents planning a career in primary care pediatrics and to present strategies for addressing the gaps.

Methods
Surveys were sent to all graduates of the University of Colorado Denver Pediatric Residency Program (2003–2006) 3 years after completion of training. Respondents were asked to evaluate aspects of their training, using a 5-point Likert scale and evaluating each item ranging from “not at all well prepared” to “extremely well prepared” for their future career. In addition, focus groups were conducted with practitioners in 8 pediatric practices in Colorado. Sessions were transcribed and hand coded by 2 independent coders.

Results
Survey data identified training in behavior and development (mean score, 3.72), quality improvement and patient safety strategies (mean, 3.57), and practice management (mean, 2.46) as the weakest aspects of training. Focus groups identified deficiencies in training in mental health, practice management, behavioral medicine, and orthopedics. Deficiencies noted in curriculum structure were lack of residents' long-term continuity of relationships with patients; the need for additional training in knowledge, skills, and attitudes needed for primary care (perhaps even a fourth year of training); and a training structure that facilitates greater resident autonomy to foster development of clinical capability and self-confidence.

Conclusions
Important gaps were identified in the primary care training of pediatric residents. These data support the need to develop more career-focused training.