bluuebunny/crossref_metadata_2025_split huggingface dataset:
System-Based Approach to Educating Internal Medicine Residents on Preventable Hospital Readmissions
Authors: Njeim Mario , Chiha Maguy , Whitehouse Sarah , Baker-Genaw Kimberly 
Published: July 2013

Abstract

Background
A literature gap exists in educating internal medicine residents about hospital readmissions and how to prevent them.

Intervention
The study aimed to implement a readmissions education initiative for general internal medicine inpatient resident teams in 3 general practice units at an urban, tertiary hospital.

Methods
Senior residents were given access to a daily list of readmissions, used a readmission assessment tool to investigate causes and to assess whether each readmission was preventable, led a monthly general practice unit team meeting to discuss each case, and presented their findings at the monthly multidisciplinary readmissions meeting for additional feedback. For program evaluation, we hypothesized that the “preventable” readmissions count tracked via the readmissions assessment tool would increase as residents became better educated on the root causes of readmissions. We also conducted a survey to assess perception of the readmissions education initiative.

Results
“Preventable” readmissions increased from 21% for the first 3 months of the intervention (September–November 2010) to 46% for the most recent 3 months (January–March 2011). The survey showed that 98% (41 of 42) of respondents who had attended a multidisciplinary readmissions meeting felt involved in an effort to review or improve the rate of hospital readmissions, whereas only 40% (21 of 53) of the group that never attended a session shared the same answer.

Conclusions
This initiative required few resources, and it appeared to help residents identify “preventable” reasons for readmissions, as well as increased their perceptions of being actively involved in reducing hospital readmissions. The intervention was not associated with a statistically significant reduction in readmissions, which may be influenced primarily by multiple factors outside residents' control.
Developing a Career in Global Health: Considerations for Physicians-in-Training and Academic Mentors
Authors: Nelson Brett D. , Kasper Jennifer , Hibberd Patricia L. , Thea Donald M. , Herlihy Julie M. 
Published: July 2013

Abstract

Background
Global health is an expansive field, and global health careers are as diverse as the practice of medicine, with new paths being forged every year. Interest in global health among medical students, residents, and fellows has never been higher. As a result, a greater number of these physicians-in-training are participating in global health electives during their training. However, there is a gap between the level of trainee interest and the breadth and depth of educational opportunities that prepare them for a career in global health.

Objective
Global health experiences can complement and enhance each step of traditional physician training, from medical school through residency and fellowship. Global health experiences can expose trainees to patients with diverse pathologies, improve physical exam skills by decreasing reliance on laboratory tests and imaging, enhance awareness of costs and resource allocation in resource-poor settings, and foster cultural sensitivity. The aim of this article is to describe issues faced by physicians-in-training and the faculty who mentor them as trainees pursue careers in global health.

Methods
We conducted a narrative review that addresses opportunities and challenges, competing demands on learners' educational schedules, and the need for professional development for faculty mentors.

Conclusions
A widening gap between trainee interest and the available educational opportunities in global health may result in many medical students and residents participating in global health experiences without adequate preparation and mentorship. Without this essential support, global health training experiences may have detrimental consequences on both trainees and the communities hosting them. We discuss considerations at each training level, options for additional training, current career models in global health, and challenges and potential solutions during training and early career development.
Anesthesiology Residents-as-Teachers Program: A Pilot Study
Authors: Berger Jeffrey S. , Daneshpayeh Negin , Sherman Marian , Gaba Nancy , Keller Jennifer , Perel Leon , Blatt Benjamin , Greenberg Larrie 
Published: July 2013

Abstract

Background
The role of residents as teachers has grown over time. Programs have been established within various specialties to formally develop these skills. Anesthesiology residents are frequently asked to provide supervision for novice learners and have numerous opportunities for teaching skills and clinical decision making. Yet, there are no educational programs described in the literature to train anesthesiology residents to teach novice learners.

Objective
To explore whether a resident-as-teacher program would increase anesthesiology residents' self-reported teaching skills.

Methods
An 8-session interactive Anesthesiology Residents-as-Teachers (ART) Program was developed to emphasize 6 key teaching skills. During a 2-year period, 14 anesthesiology residents attended the ART program. The primary outcome measure was resident self-assessment of their teaching skills across 14 teaching domains, before and 6 months after the ART program. Residents also evaluated the workshops for quality with a 9-item, postworkshop survey. Paired t testing was used for analysis.

Results
Resident self-assessment led to a mean increase in teaching skills of 1.04 in a 5-point Likert scale (P &lt; .001). Residents reported the greatest improvement in writing/using teaching objectives (+1.29, P &lt; .001), teaching at the bedside (+1.57, P  =  .002), and leading case discussions (+1.64, P  =  .001). Residents rated the workshops 4.2 out of 5 (3.9–4.7).

Conclusions
Residents rated their teaching skills as significantly improved in 13 of 14 teaching domains after participation in the ART program. The educational program required few resources and was rated highly by residents.
Love Letters: An Anthology of Constructive Relationship Advice Shared Between Junior Mentees and Their Mentors
Authors: Gillespie Suzanne M. , Thornburg Loralei L. , Caprio Thomas V. , Medina-Walpole Annette 
Published: July 2013

Abstract
Mentorship is critical to the professional success of physicians, physicians-in-training, and junior faculty in academic practice. There are challenges to being a thoughtful and effective mentor and to being an engaged mentee. Many physicians and physicians-in-training cite difficulty finding professional time to dedicate to building their mentoring relationships, particularly given demanding clinical workloads and competing time commitments. Therefore, making the most out of the time in mentoring relationships is key to success. We present a collection of frustrations and good advice that have been passed between mentees and mentors on improving the mentor-mentee relationship. The information was compiled from actual interactions between mentors and mentees, and these “love letters” draw on complex associations, which like any “committed” relationship require constant reevaluation and discussion to bring them to their full potential.
An Observational Study of Hospital Paging Practices and Workflow Interruption Among On-Call Junior Neurological Surgery Residents
Authors: Fargen Kyle M. , O'Connor Timothy , Raymond Steven , Sporrer Justin M. , Friedman William A. 
Published: July 2013

Abstract

Background
Previous studies suggest that nonurgent pages comprise a substantial portion of the pages received by residents while on duty. We evaluated the number, type, and urgency of pages received and the task being performed at the time of paging by on-call junior neurosurgery residents at a large teaching hospital, with the aim of providing insight into mechanisms that can be developed to improve paging patterns and ultimately reduce physician distractions due to nonurgent communications.

Methods
For eight 12-hour call sessions, a medical student shadowed the on-call junior neurosurgery resident and recorded all pages received and the time, paging number and location, priority of the page (nonurgent, urgent, or emergency), and the activity the resident performed when the page was received. During one 5-hour session, a recorder measured the amount of time spent returning pages.

Results
During the study period, 439 communications were recorded (mean of 54.9 per 12-hour session; range, 33–75). Communications occurred at a rate of every 13 minutes and ranged from every 34 minutes to every 8.7 minutes. Paging remained frequent even during the hours when on-call residents are most likely to sleep (2–5 am), with an average of 4 communications per hour. The time to return pages ranged from 15 to 174 seconds (mean, 79.7 seconds). Most pages were nonurgent (68.3%) and occurred during patient care activities (65%).

Conclusions
Paging communications were frequent. Most pages were nonurgent and were received during important patient care activities. This suggests that a viable solution must address the work context of the individual being paged and the individual initiating the page to ensure that urgent communications are properly prioritized and attended to.
Quality and Safety Training in Primary Care: Making an Impact
Authors: Byrne John M. , Hall Susan , Baz Sam , Kessler Todd , Roman Maher , Patuszynski Mark , Thakkar Kruti , Kashner T. Michael 
Published: July 2013

Abstract

Purpose
Preparing residents for future practice, knowledge, and skills in quality improvement and safety (QI/S) is a requisite element of graduate medical education. Despite many challenges, residency programs must consider new curricular innovations to meet the requirements. We report the effectiveness of a primary care QI/S curriculum and the role of the chief resident in quality and patient safety in facilitating it.

Method
Through the Veterans Administration Graduate Medical Education Enhancement Program, we added a position for a chief resident in quality and patient safety, and 4 full-time equivalent internal medicine residents, to develop the Primary Care Interprofessional Patient-Centered Quality Care Training Curriculum. The curriculum includes a first-or second-year, 1-month block rotation that serves as a foundational experience in QI/S and interprofessional care. The responsibilities of the chief resident in quality and patient safety included organizing and teaching the QI/S curriculum and mentoring resident projects. Evaluation included prerotation and postrotation surveys of self-assessed QI/S knowledge, abilities, skills, beliefs, and commitment (KASBC); an end-of-the-year KASBC; prerotation and postrotation knowledge test; and postrotation and faculty surveys.

Results
Comparisons of prerotation and postrotation KASBC indicated significant self-assessed improvements in 4 of 5 KASBC domains: knowledge (P &lt; .001), ability (P &lt; .001), skills (P &lt; .001), and belief (P &lt; .03), which were sustained on the end-of-the-year survey. The knowledge test demonstrated increased QI/S knowledge (P  =  .002). Results of the postrotation survey indicate strong satisfaction with the curriculum, with 76% (25 of 33) and 70% (23 of 33) of the residents rating the quality and safety curricula as always or usually educational. Most faculty members acknowledged that the chief resident in quality and patient safety enhanced both faculty and resident QI/S interest and participation in projects.

Conclusions
Our primary care QI/S curriculum was associated with improved and persistent resident self-perceived knowledge, abilities, and skills and increased knowledge-based scores of QI/S. The chief resident in quality and patient safety played an important role in overseeing the curriculum, teaching, and providing leadership.
Essential Facets of Competence That Enable Trust in Graduates: A Delphi Study Among Physician Educators in the Netherlands
Authors: Wijnen-Meijer Marjo , van der Schaaf Marieke , Nillesen Kirstin , Harendza Sigrid , ten Cate Olle 
Published: July 2013

Abstract

Background
There is a need for valid methods to assess the readiness for clinical practice of recently graduated physicians. To develop these methods, it is relevant to know the general features of trainees' performance that facilitate supervisors' trust in their ability to perform critical clinical tasks.

Objective
To discover such essential facets of competence (FOCs), based on the opinion of experienced physician educators.

Methods
We conducted a Delphi study, consisting of 2 rounds, among 18 experienced physician educators in the Netherlands. Mean, standard deviation, level of agreement, and skewness were calculated for the importance of FOCs for making entrustment decisions. The study yielded a list of 25 FOCs.

Results
In the first round, means were between 6.50 and 7.00 on a 7-point Likert scale (SD, 0.42–2.18); in the second round, means ranged from 5.45 to 6.90 (SD, 0.3–2.02). The level of agreement was high for 92% of the FOCs in the first round and 100% of the FOCs in the second round.

Conclusions
Our Delphi study found consensus among experts about FOCs that are important for clinical entrustment decisions.
Pilot Study of iPad Incorporation Into Graduate Medical Education
Authors: Lobo Mark J. , Crandley Edwin F. , Rumph Jake S. , Kirk Susan E. , Dunlap Neal E. , Rahimi Asal S. , Turner A. Benton , Larner James M. , Read Paul W. 
Published: July 2013

Abstract

Background
Increased documentation and charting requirements are challenging for residents, given duty hour limits. Use of mobile electronic devices may help residents complete these tasks efficiently.

Objective
To collect initial data on usage rates, information technology (IT) support requirements, and resident use of iPads during training.

Methods
In this pilot study, we provided 12 residents/fellows from various specialties at the University of Virginia with an iPad with IT support. The system used a virtual private network with access to the institution's electronic health record. Participants were allowed to develop their own methods and systems for personalized iPad use, and after 9 months they provided data on the utility of the iPad. Feedback from the IT team also was obtained.

Results
Average iPad use was 2.1 h/d (range, 0.5–6 h/d). The average self-reported reduction in administrative work due to the iPad was 2.7 h/wk (range, 0–9 h/wk). A total of 75% (9 of 12) of the users would recommend universal adoption among residents and fellows. More than 90% (11 of 12) of users reported the iPad would improve communication for coordination of care. A total of 68% (8 of 12) of users reported that an iPad facilitated their activities as educators of medical students and junior residents. Residents cited slow data entry into the electronic health record and hospital areas lacking Wi-Fi connectivity as potential drawbacks to iPad use. The IT team reported minimal support time for device setup, maintenance, and upgrades, and limited security risks.

Conclusions
The iPad may contribute to increased clinical efficiency, reduced hours spent on administrative tasks, and enhanced educational opportunities for residents, with minimal IT support.
An Experiential Community Orientation to Improve Knowledge and Assess Resident Attitudes Toward Poor Patients
Authors: Wallace Erik A. , Miller-Cribbs Julie E. , Duffy F. Daniel 
Published: July 2013

Abstract

Background
Future physicians may not be prepared for the challenges of caring for the growing population of poor patients in this country. Given the potential for a socioeconomic “gulf” between physicians and patients and the lack of curricula that address the specific needs of poor patients, resident knowledge about caring for this underserved population is low.

Intervention
We created a 2-day Resident Academy orientation, before the start of residency training, to improve community knowledge and address resident attitudes toward poor patients through team-based experiential activities. We collected demographic and satisfaction data through anonymous presurvey and postsurvey t tests, and descriptive analysis of the quantitative data were conducted. Qualitative comments from open-ended questions were reviewed, coded, and divided into themes. We also offer information on the cost and replicability of the Academy.

Results
Residents rated most components of the Academy as “very good” or “excellent.” Satisfaction scores were higher among residents in primary care training programs than among residents in nonprimary care programs for most Academy elements. Qualitative data demonstrated an overall positive effect on resident knowledge and attitudes about community resource availability for underserved patients, and the challenges of poor patients to access high-quality health care.

Conclusions
The Resident Academy orientation improved knowledge and attitudes of new residents before the start of residency, and residents were satisfied with the experience. The commitment of institutional leaders is essential for success.
Systems-Based Content in Medical Morbidity and Mortality Conferences: A Decade of Change
Authors: Gonzalo Jed D. , Yang Julius J. , Huang Grace C. 
Published: July 2013

Abstract

Background
Following the Accreditation Council for Graduate Medical Education recommendations in 1999 to foster education in the systems-based practice (SBP) competency by examining adverse clinical events, institutions have modified the morbidity and mortality conference (MMC) to increase SBP-related discussion. We sought to examine the extent to which SBP-related content has increased in our department's MMCs compared with MMCs 10 years prior.

Method
We qualitatively analyzed audio recordings of our MMCs during 2 academic years, 1999–2000 (n  =  30) and 2010–2011 (n  =  30). We categorized comments and questions from moderators and faculty as SBP or non-SBP and characterized conferences by whether adverse events were presented and which systems issues were discussed.

Results
Compared with MMCs in 1999–2000, present-day MMCs included a greater average percentage of SBP comments stated (69% versus 12%; P ≤ .001) and questions asked (13% versus 1%; P  =  .001) by the moderator, SBP comments stated (44% versus 4%; P ≤ .001) and questions asked (19% versus 1%; P ≤ .001) by faculty, and were more likely to present adverse events (87% versus 13%; P &lt; .001). Interrater reliability for the distinction between SBP and non-SBP content was good (κ  =  0.647). Most common categories of systems issues discussed in 2010–2011 were critical laboratory value processing and reporting, institutional policies, and hospital-based factors.

Conclusions
Over the past decade, our MMC has transformed to include more discussion of SBP-related content and adverse events. The MMC can be used to educate residents in SBP and can also serve as a cornerstone for departmental quality and safety initiatives.
Interns' Experiences of Disruptive Behavior in an Academic Medical Center
Authors: Mullan Charles P. , Shapiro Jo , McMahon Graham T. 
Published: July 2013

Abstract

Background
The first year of graduate medical education is an important period in the professional development of physicians. Disruptive behavior interferes with safe and effective clinical practice.

Objective
To determine the frequency and nature of disruptive behavior perceived by interns and attending physicians in a teaching hospital environment.

Method
All 516 interns at Partners HealthCare (Boston, MA) during the 2010 and 2011 academic years were eligible to complete an anonymous questionnaire. A convenience nonrandom sample of 40 attending physicians also participated.

Results
A total of 394 of 516 eligible interns (76.4%) participated. Attendings and interns each reported that their team members generally behaved professionally (87.5% versus 80.4%, respectively). A significantly greater proportion of attendings than interns felt respected at work (90.0% versus 71.5% respectively; P  =  .01). Disruptive behavior was experienced by 93% of interns; 54% reported that they experienced it once a month or more. Interns reported disruptive behavior significantly more frequently than attending physicians, including increased reports of condescending behavior (odds ratio [OR], 5.46 for interns compared with attendings; P &lt; .001), exclusion from decision making (OR, 6.97; P &lt; .001), and berating (OR, 4.84; P  =  .02). Inappropriate jokes, abusive language, and gender bias were also reported, and they were not significantly more frequent among interns than attending physicians. Interns most frequently identified nurses as the source of disruption, and were significantly more likely than faculty to identify nurses as the source of disruptive behavior (OR, 10.40; P &lt; .001). Attendings reported other physicians as the most frequent source of disruption.

Conclusions
Although interns generally feel respected at work, they frequently experience disruptive behavior. Interns described more disruptive behaviors than a convenience sample of attending physicians at our institution.
“If You Build It, They Will Come”: Attitudes of Medical Residents and Fellows About Seeking Services in a Resident Wellness Program
Authors: Ey Sydney , Moffit Mary , Kinzie J. Mark , Choi Dongseok , Girard Donald E. 
Published: July 2013

Abstract

Background
High rates of burnout and distress in resident physicians suggest a significant number would benefit from counseling.

Intervention
A resident wellness program (RWP) was designed to lower known barriers limiting resident access to services.

Methods
In 2011, medical residents and fellows were surveyed and logistic regression analyses were conducted to identify demographic and training program differences in perceived barriers and willingness to access the RWP.

Results
Of the 88% of trainees who knew about the RWP, 87% indicated they would be very likely or somewhat likely to seek out services. Time remained the biggest barrier for residents to getting help. Being male (odds ratio [OR]  =  0.54, 95% confidence interval [CI] 0.34–0.84) or an ethnic/racial minority (OR  =  0.49, 95% CI 0.28–0.85) was associated with greater unwillingness to seek counseling. Reluctance to access the RWP was associated with concerns about helpfulness, confidentiality, being unable to take a break, and stigma. Women (OR  =  1.60, 95% CI 1.06–2.42) and primary care residents (OR  =  1.58, 95% CI 0.98–2.54) were more likely to be concerned about taking a break. Men were more likely to question the helpfulness of counseling (OR  =  0.55, 95% CI 0.36–0.85).

Conclusions
The RWP removed barriers of cost and knowledge about counseling services. More educational outreach is needed to address sex and ethnic differences about RWP utilization and attitudes in medical culture about a physician's right to address personal health care needs.