bluuebunny/crossref_metadata_2025_split huggingface dataset:
Value Placed on Formal Training in Education by Pediatric Department Chairs and Residency Program Directors
Authors: Turner Teri L. , Ward Mark A. , Palazzi Debra L. , Lorin Martin I. 
Published: July 2013

Abstract

Background
While much is known about how educational leaders at the medical school level (eg, deans) view the importance of formal training in education for medical school teachers, little is known about how leaders at the clinical level (eg, department chairs) view such training. We sought to determine how pediatric department chairs and residency program directors view the value of formal training in education, such as that at a Master of Education (MEd) level, and to estimate the number of clinical pediatric faculty with or pursuing such training.

Methods
A survey designed to assess the value placed on formal training in education and to estimate the number of clinical faculty with or pursuing such training was mailed to pediatric department chair persons and residency program directors at all 131 allopathic medical schools in the United States and Puerto Rico.

Results
Eighty department chairs (61%) responded, and most indicated that when hiring new faculty, they view an applicant with an MEd as having an advantage. Both chairs and residency directors considered an MEd to be advantageous for a residency director by a ranking of 4.5 and 4.2, respectively, on a scale of 1 to 5 (P  =  .008). Of the 80 chairs who responded, 58.8% of respondents reported one or more faculty in their department had or was pursuing an MEd. Of the 72 responding residency directors (55%), 11 respondents (15.3%) indicated that they had an MEd.

Conclusion
More than half the medical school pediatric chairs responding to the survey had one or more clinical faculty with or pursuing an MEd in their departments. Survey results indicated that such training is valued by both department chairs and residency directors. Given the time and expense involved in obtaining an MEd, awareness of these data may be helpful to those considering pursuing, offering, or requiring such training.
Barriers to Implementing the ACGME Outcome Project: A Systematic Review of Program Director Surveys
Authors: Malik Mohammad U. , Diaz Voss Varela David A. , Stewart Charles M. , Laeeq Kulsoom , Yenokyan Gayane , Francis Howard W. , Bhatti Nasir I. 
Published: July 2013

Abstract

Introduction
The Accreditation Council for Graduate Medical Education (ACGME) introduced the Outcome Project in July 2001 to improve the quality of resident education through competency-based learning. The purpose of this systematic review is to determine and explore the perceptions of program directors regarding challenges to implementing the ACGME Outcome Project.

Methods
We used the PubMed and Web of Science databases and bibliographies for English-language articles published between January 1, 2001, and February 17, 2012. Studies were included if they described program directors' opinions on (1) barriers encountered when attempting to implement ACGME competency-based education, and (2) assessment methods that each residency program was using to implement competency-based education. Articles meeting the inclusion criteria were screened by 2 researchers. The grading criterion was created by the authors and used to assess the quality of each study.

Results
The survey-based data reported the opinions of 1076 program directors. Barriers that were encountered include: (1) lack of time; (2) lack of faculty support; (3) resistance of residents to the Outcome Project; (4) insufficient funding; (5) perceived low priority for the Outcome Project; (6) inadequate salary incentive; and (7) inadequate knowledge of the competencies. Of the 6 competencies, those pertaining to patient care and medical knowledge received the most responses from program directors and were given highest priority.

Conclusions
The reviewed literature revealed that time and financial constraints were the most important barriers encountered when implementing the ACGME Outcome Project.
Patient Communication During Handovers Between Emergency Medicine and Internal Medicine Residents
Authors: Fischer Miriam , Hemphill Robin R. , Rimler Eva , Marshall Stephanie , Brownfield Erica , Shayne Philip , Di Francesco Lorenzo , Santen Sally A. 
Published: July 2013

Abstract

Background
Communication failures are a key cause of medical errors and are particularly prevalent during handovers of patients between services.

Objective
To explore current perceptions of effectiveness in communicating critical patient information during admission handovers between emergency medicine (EM) residents and internal medicine (IM) residents.

Methods
Study design was a survey of IM and EM residents at a large urban hospital. Residents were surveyed about whether critical information was communicated during patient handovers. Measurements included comparisons between IM and EM residents about their perceptions of effective communication of key patient information and the quality of handovers.

Results
Ninety-three percent of EM residents (50 of 54) and 80% of IM residents (74 of 93) responded to the survey. The EM residents judged their handover performance to be better than how their IM colleagues assessed them on most questions. The IM residents reported that one-half of the time, EM residents provided organized and clear information, whereas EM residents self-reported that they did so most of the time (80%–90%). The IM residents reported that 25% of handovers were suboptimal and resulted in admission to an inappropriate level of care, and 10% led to harm or delay in care. The EM residents reported suboptimal communication was less common (5%). On the global assessment of whether the admission handover provided the information needed for good patient care, IM residents rated the quality of the handover data lower than did responding EM residents.

Conclusions
There are gaps in communicating critical patient information during admission handovers as perceived by EM and IM residents. This information can form the basis for efforts to improve these handovers.
Pediatrics Residents' Perspectives on Family-Centered Rounds: A Qualitative Study at 2 Children's Hospitals
Authors: Mittal Vineeta , Krieger Evelina , Lee Benjamin C. , Kind Terry , McCavit Timothy , Campbell Joyce , Ottolini Mary C. , Flores Glenn 
Published: July 2013

Abstract

Background
Many academic hospitals have incorporated family-centered rounds, yet little is known about pediatrics residents' perspectives on the educational impact of these rounds.

Objective
To identify pediatrics residents' knowledge, attitudes, and beliefs about family-centered rounds, including perceived benefits and barriers.

Methods
We conducted focus groups of residents exposed to family-centered rounds at 2 university-affiliated, freestanding children's hospitals. Focus group data were analyzed using grounded theory.

Results
A total of 24 residents participated in 4 focus groups. Residents reported that family-centered rounds enhance education by increasing patient encounters and improving physical exam skills, direct observation, real-time feedback, and attending role modeling; improve parent satisfaction, interpersonal and communication skills, and safety; and reduce length of stay. Physical constraints (large teams and small rooms), lack of uniform approaches to family-centered rounds, variable attending teaching styles, and specific conditions (child abuse, patients on isolation) were cited barriers.

Conclusions
Pediatrics residents report that well-conducted family-centered rounds improve their education and the quality of patient care, including parent satisfaction, communication with families, and patients' length of stay. Standardizing family-centered rounds and reducing attending variability in teaching style might further enhance residents' educational experiences.
Remediation in the Context of the Competencies: A Survey of Pediatrics Residency Program Directors
Authors: Riebschleger Meredith P. , Haftel Hilary M. 
Published: July 2013

Abstract

Background
The 6 competencies defined by the Accreditation Council for Graduate Medical Education provide the framework of assessment for trainees in the US graduate medical education system, but few studies have investigated their impact on remediation.

Methods
We obtained data via an anonymous online survey of pediatrics residency program directors. For the purposes of the survey, remediation was defined as “any form of additional training, supervision, or assistance above that required for a typical resident.” Respondents were asked to quantify 3 groups of residents: (1) residents requiring remediation; (2) residents whose training was extended for remediation purposes; and (3) residents whose training was terminated owing to issues related to remediation. For each group, the proportion of residents with deficiencies in each of the 6 competencies was calculated.

Results
In all 3 groups, deficiencies in medical knowledge and patient care were most common; deficiencies in professionalism and communication were moderately common; and deficiencies in systems-based practice and practice-based learning and improvement were least common. Residents whose training was terminated were more likely to have deficiencies in multiple competencies.

Conclusion
Although medical knowledge and patient care are reported most frequently, deficiencies in any of the 6 competencies can lead to the need for remediation in pediatrics residents. Residents who are terminated are more likely to have deficits in multiple competencies. It will be critical to develop and refine tools to measure achievement in all 6 competencies as the graduate medical education community may be moving further toward individualized training schedules and competency-based, rather than time-based, training.
Increasing Faculty Attendance at Emergency Medicine Resident Conferences: Does CME Credit Make a Difference?
Authors: Lefebvre Cedric W. , Hiestand Brian , Bond Michael C. , Fox Sean M. , Char Doug , Weber Drew S. , Glenn David , Patterson Leigh A. , Manthey David E. 
Published: July 2013

Abstract

Background
Faculty involvement in resident teaching events is beneficial to resident education, yet evidence about the factors that promote faculty attendance at resident didactic conferences is limited.

Objective
To determine whether offering continuing medical education (CME) credits would result in an increase in faculty attendance at weekly emergency medicine conferences and whether faculty would report the availability of CME credit as a motivating factor.

Methods
Our prospective, multi-site, observational study of 5 emergency medicine residency programs collected information on the number of faculty members present at CME and non-CME lectures for 9 months and collected information from faculty on factors influencing decisions to attend resident educational events and from residents on factors influencing their learning experience.

Results
Lectures offering CME credit on average were attended by 5 additional faculty members per hour, compared with conferences that did not offer CME credit (95% confidence interval [CI], 3.9–6.1; P &lt; .001). Faculty reported their desire to “participate in resident education” was the most influential factor prompting them to attend lectures, followed by “explore current trends in emergency medicine” and the lecture's “specific topic.” Faculty also reported that “clinical/administrative duties” and “family responsibilities” negatively affected their ability to attend. Residents reported that the most important positive factor influencing their conference experience was “lectures given by faculty.”

Conclusions
Although faculty reported that CME credit was not an important factor in their decision to attend resident conferences, offering CME credit resulted in significant increases in faculty attendance. Residents reported that “lectures given by faculty” and “faculty attendance” positively affected their learning experience.
Operationalizing the Internal Medicine Milestones–An Early Status Report
Authors: Nabors Christopher , Peterson Stephen J. , Forman Leanne , Stallings Gary W. , Mumtaz Arif , Sule Sachin , Shah Tushar , Aronow Wilbert , Delorenzo Lawrence , Chandy Dipak , Lehrman Stuart G. , Frishman William H. , Holmboe Eric 
Published: July 2013

Abstract

Background
The internal medicine milestones were developed to advance outcomes-based residency training and will play an important role in the next accreditation system.

Innovation
As an element of our program's participation in the internal medicine educational innovations project, we implemented a milestones-based evaluation process in our general medicine and pulmonary-critical care rotations on July 1, 2010.

Measures
Outcomes assessed included survey-rated acceptability to participating faculty, residents, and clinical competency committee members.

Results
Faculty and residents agreed that the milestones promoted a common understanding of what knowledge, skills, and attitudes should be displayed at particular points in residents' professional development and enhanced evaluators' ability to provide specific performance feedback. Most residents and faculty members agreed that the milestones promoted fairness and uniformity in the evaluation process. Clinical competency committee members agreed the milestones improved the quality of information available for deliberations and resulted in more uniform promotion standards. Faculty rated the use of too many milestones per form/tool at a mean of 7.3 (where 1 was minimally problematic, and 10 was maximally problematic) and the potential for evaluator fatigue (mean, 8.2) as the most significant challenges to the use of milestones. Eight of 12 faculty members would recommend milestones in other programs; 4 were uncertain.

Conclusions
Despite logistical challenges, educators and trainees found that milestones promoted a common understanding of what knowledge, skills and attitudes should be displayed at particular stages of training; permitted greater specificity in performance feedback; and enhanced uniformity and fairness in promotion decisions.
The Writing Retreat: A High-Yield Clinical Faculty Development Opportunity in Academic Writing
Authors: Cable Christian T. , Boyer Debra , Colbert Colleen Y. , Boyer Edward W. 
Published: July 2013

Abstract

Background
The need for consistent academic productivity challenges junior clinician-scholars, who often lack the aptitude to ensure efficient production of manuscripts.

Intervention
To solve this problem, an academic division of a major medical center developed an off-site writing retreat. The purpose of the retreat was not to teach writing skills, but to offer senior mentor assistance with a focus on the elements of manuscript writing.

Methods
The retreat paired senior faculty members with junior staff. Senior faculty identified manuscript topics and provided real-time writing and editing supervision. Team-building exercises, midcourse corrections, and debriefing interviews were built into the retreat. The number of manuscripts and grant proposals generated during the 2008–2011 retreats was recorded, and the program was evaluated by using unstructured debriefing interviews.

Results
An average of 6 to 7 faculty members and fellows participated in each retreat. During the past 4 years, participants produced an average of 3 grant proposals and 7 manuscripts per retreat. After the writing retreat, each fellow and junior faculty member produced an average of 4 scholarly products per year, compared to fewer than 2 for prior years' retreats. Participant feedback indicated the success of the retreat resulted from protected time, direct mentorship by the scholars involved, and pairing of authors, which allows for rapid production of manuscripts and accelerated the editing process. More than 80% of mentors returned each year to participate.

Conclusions
The writing retreat is a feasible, effective strategy to increase scholarship among faculty, acceptable to mentees and mentors, and sustainable over time.
Feasibility and Acceptability of a Structured Curriculum in Teaching Procedural and Basic Diagnostic Ultrasound Skills to Internal Medicine Residents
Authors: Schnobrich Daniel J. , Olson Andrew P. J. , Broccard Alain , Duran-Nelson Alisa 
Published: July 2013

Abstract

Background
Point-of-care ultrasound has emerged as a powerful diagnostic tool and is also being increasingly used by clinicians to guide procedures. Many current and future internists desire training, yet no formal, multiple-application, program-wide teaching interventions have been described.

Intervention
We describe a structured 30-hour ultrasound training course in diagnostic and procedural ultrasound implemented during intern orientation. Internal medicine interns learned basic ultrasound physics and machine skills; focused cardiac, great vessel, pulmonary, and abdominal ultrasound diagnostic examinations; and procedural applications.

Results
In postcourse testing, learners demonstrated the ability to acquire images, had significantly increased knowledge scores (P &lt; .001), and demonstrated good performance on practical scenarios designed to test abilities in image acquisition, interpretation, and incorporation into medical decision making. In the postcourse survey, learners strongly agreed (4.6 of 5.0) that ultrasound skills would be valuable during residency and in their careers.

Conclusions
A structured ultrasound course can increase knowledge and can result in learners who have skills in image acquisition, interpretation, and integration in management. Future work will focus on refining and improving these skills to allow these learners to be entrusted with the use of ultrasound independently for patient care decisions.
Periprosthetic Femoral Insufficiency Fracture in a Patient on Long-term Bisphosphonate Therapy
Authors: Wellman Samuel S , Attarian David E , Schaeffer Jordan F 
Published: July 2013

ABSTRACT
Recent literature shows an association between long-term bisphosphonate therapy and low-energy fractures of the subtrochanteric femur. It is thought that the pharmacology of bisphosphonates and stress characteristics of the sub-trochanteric femur predispose patients on long-term therapy to fracture. There are few reports in the literature of bisphos-phonate-associated periprosthetic fractures with the characteristic fracture pattern. We report a case in a patient with a 10- year history of sustained bisphosphonate use. The patient is a 79-year-old female that developed new thigh pain 9 years following a cemented total hip arthroplasty. Radiographs revealed lateral cortical thickening and a transverse periprosthetic stress fracture of the lateral femoral cortex at the level of the distal stem. This fracture appears consistent with a bisphosphonate-associated insufficiency fracture, demonstrating that this pattern is not isolated to nonarthroplasty patients.
Schaeffer JF, Attarian DE, Wellman SS. Periprosthetic Femoral Insufficiency Fracture in a Patient on Long-term Bisphosphonate Therapy. The Duke Orthop J 2012;2(1):66-69.
Allograft Reconstruction of Irreparable Peroneal Tendon Tears: A Preliminary Report
Authors: Mook William R , Nunley James A 
Published: July 2013

ABSTRACT

Background
Peroneal tendon injuries represent a significant but underappreciated source of lateral ankle pain. Partial thickness tears of the peroneus brevis amenable to direct repair techniques are common. Irreparable tears are uncommon and require more complex surgical decision-making. Intercalary segment allograft reconstruction has been previously described as a treatment option; however, there are no reports of the outcomes of this technique in the literature. We present our results utilizing this technique.

Materials and methods
A retrospective chart review was conducted to identify all patients who underwent intercalary allograft reconstruction of the peroneus brevis. Mechanism of injury, concomitant operative procedures, pertinent radiographic findings, pre- and postoperative physical examination, intercalary graft length, medical history, visual analog scores (VAS) for pain, short form-12 (SF-12) physical health survey, lower extremity functional scores (LEFS), and complications were reviewed.

Results
Eight patients with eight peroneus brevis tendon ruptures requiring reconstruction were indentified. Mean follow-up was 15 months (range, 10-31). The average length of the intercalary segment reconstructed was 12 cm ± 3.9 (range, 8-20). The average postoperative VAS decreased to 1.0 ± 1.6 from 4.0 ± 2.2 (p = 0.01). No patient had a higher postoperative pain score than preoperative pain score. Average postoperative eversion strength improved from 3.5 ± 1.2 to 4.81 ± 0.37 (p = 0.03). The average SF-12 survey improved from 41.1 ± 12.3 to 50.2 ± 9.31 (p = 0.06). The average LEFS improved from 53.3 ± 17.0 to 95.25 ± 10.0 (p = 0.02). Four patients experienced sensory numbness in the sural nerve distribution, and two of these were transient. There were no postoperative wound healing complications, infections, tendon reruptures or reoperations. No allograft associated complications were encountered. All patients returned to their preoperative activity levels.

Conclusion
Allograft reconstruction of the peroneus brevis can improve strength, decrease pain, and yield satisfactory patientreported outcomes. Importantly, this can be successfully performed without incurring the deleterious effects associated with tendon transfer procedures. Our results suggest that allograft reconstruction may be a safe and reasonable alternative in the treatment of irreparable peroneal tendon ruptures.

Level of evidence
Therapeutic level IV.
Mook WR, Nunley JA. Allograft Reconstruction of Irreparable Peroneal Tendon Tears: A Preliminary Report. The Duke Orthop J 2013;3(1):1-7. I
Post-traumatic Arthritis: An Update
Authors: Mangiapani Daniel S , Lewis John S , Furman Bridgette D , Kraus Virginia B , Guilak Farshid 
Published: July 2013

ABSTRACTPost-traumatic arthritis (PTA) is a frequent cause of disability following trauma of weight-bearing joints and is associated with significant physical impairment and loss of function. The development of PTA often occurs after an articular fracture. Currently, the only treatment option available to orthopaedic surgeons in the management of an acute articular fracture is anatomic fracture reduction. The complex pathway involved in the development and progression of PTA after articular injury, however, remains unknown and largely unstudied. Proinflammatory cytokines, such as interleukin-1 (IL-1) and tumor necrosis factor-ƒÑ (TNF-ƒÑ) are upregulated in injured and degenerative joints and may play an important role in the pathogenesis of PTA. The central goal of ongoing research is to understand the sequence of biologic events¡Xdistinct from mechanical disruption of the joint surface¡Xthat cause progressive joint degeneration and ultimately the development of PTA. Promising new interventions on the molecular level have been shown to slow or halt the progression of these adverse events in animal models.Lewis JS Jr, Mangiapani DS, Furman BD, Kraus VB, Guilak F, Olson SA. Post-traumatic Arthritis: An Update. The Duke Orthop J 2013;3(1):32-35.