bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Audit and Feedback on Improving Handovers: A Nonrandomized Comparative Study
Authors: O'Horo John Charles , Omballi Mohamed , Tran Tony K. , Jordan Jeffrey P. , Baumgardner Dennis J. , Gennis Mark A. 
Published: July 2013

Abstract

Background
High-quality, shift-to-shift handovers by residents are critical to ensuring to patient safety. The 2011 Accreditation Council for Graduate Medical Education duty hour requirements have increased the number of handovers occurring daily, necessitating new approaches to this challenge. Research suggests standardized approaches, electronic systems, and education programs can improve the handover process.

Methods
We conducted a 2-phase, observational study comparing an electronic handover system (experimental) in one clinical setting to a standard card-based system (control) at a second site. Outcome data included an objective assessment of the completeness and accuracy of handovers, and resident assessment of the handover systems. In phase 1, data were recorded at both sites and not shared with residents. In phase 2, data from the experimental system were used to provide standardized feedback to residents on the quality of their handovers.

Results
A total of 3184 individual patient sign-outs were evaluated during the 11-month period. Following introduction of a feedback intervention in the experimental arm, errors were present in only 5.2% of handovers, compared with 16.1% of controls (P &lt; .001), and 67% of the 38 residents responding reported they perceived the experimental system as facilitating better patient care.

Conclusion
Regular, real-time feedback through an electronic handover system can improve the accuracy and completeness of handovers in patient care.
An Incremental Approach to Improving Scholarly Activity
Authors: Penrose Lindsay L. , Yeomans Edward R. , Praderio Carolina , Prien Samuel D. 
Published: July 2013

Abstract

Background
The Accreditation Council for Graduate Medical Education requires scholarly activity for both faculty and residents in obstetrics and gynecology (Ob-Gyn). There is little evidence on the most effective method to train, recruit, and retain research faculty who can mentor resident researchers at small programs.

Innovation
To address this problem, we created the “Baby Steps” program for a small university-based Ob-Gyn program.

Methods
After a thorough assessment of existing resources, a postdoctoral researcher was recruited and coupled with an established researcher to raise the standards of resident research, facilitate and coordinate resident projects, and support clinical faculty participation in research activities. Grant submissions, grants awarded, publications submitted, presentations, and awards were tracked before and after the implementation of the Baby Steps program for faculty and residents.

Results
After 2 years the program has already begun to show an increase in scholarly activity. In a program of 12 residents, 8 made one or more presentations at regional or national meetings within the previous 24 months. Additionally, 8 of 12 clinical faculty members were engaged as mentors in resident research, compared with only 3 in past years. Further, abstract, paper, and grant submissions by faculty increased approximately 25%.

Conclusion
The addition of a mentored postdoctoral researcher was associated with improvements to both resident and faculty research activities. Based on this success, a sister residency program has incorporated the Baby Steps approach into its training.
Influence of Clinical Experience and Productivity on Emergency Medicine Faculty Teaching Scores
Authors: Clyne Brian , Smith Jessica L. , Napoli Anthony M. 
Published: July 2013

Abstract

Background
Commonly cited barriers to effective teaching in emergency medicine include lack of time, competing demands for patient care, and a lack of formal teaching experience. Teaching may be negatively affected by demands for increased clinical productivity, or positively influenced by clinical experience.

Objective
To examine the association between faculty teaching scores and clinical productivity, years of clinical experience, and amount of clinical contact with resident physicians.

Methods
We conducted a retrospective, observational study with existing data on full-time faculty at a high-volume, urban emergency medicine residency training program for academic year 2008–2009. Residents rated faculty on 9 domains of teaching, including willingness to teach, enthusiasm for teaching, medical knowledge, preparation, and communication. Clinical productivity data for relative value units per hour and number of patients per hour, years of clinical experience, and annual clinical hours were obtained from existing databases.

Results
For the 25 core faculty members included in the study, there was no relationship between faculty teaching scores and clinical productivity measures (relative value units per hour: r2  =  0.01, P  =  .96, patients per hour: r2  =  0.00, P  =  .76), or between teaching scores and total clinical hours with residents (r2  =  0.07, P  =  .19). There was a significant negative relationship between years of experience and teaching scores (r2  =  0.27, P &lt; .01).

Conclusions
Our study demonstrated that teaching scores for core emergency medicine faculty did not correlate with clinical productivity or amount of clinical contact with residents. Teaching scores were inversely related to number of years of clinical experience, with more experienced faculty earning the lowest teaching scores. Further study is necessary to determine if there are clinical measures that identify good educators.
A Simulation-Based Curriculum To Address Relational Crises in Medicine
Authors: Peterson Eleanor B. , Porter Melissa B. , Calhoun Aaron W. 
Published: July 2013

Abstract

Introduction
Preparing health care professionals for challenging communication tasks such as delivering bad news to patients and families is an area where a need for improved teaching has been identified.

Objectives
We developed a simulation-based curriculum to enhance the skills of health care professionals, with an emphasis on the communication of difficult or bad news, which we termed relational crises.

Methods
Our approach was based on a review of existing simulation-based curricula, with the addition of unique features, including a learner-focused needs assessment to shape curriculum development, use of 360-degree evaluations, and provision of written feedback. Development and implementation of our curriculum occurred in 3 phases. Phase I involved a multidisciplinary needs assessment, creation of a clinical scenario based on needs assessment results, and training of standardized patients. In Phase II we implemented the curriculum with 36 pediatric and internal medicine-pediatrics residents, 20 nurses, and 1 chaplain. Phase III consisted of the provision of written feedback for learners, created from the 360-degree evaluations compiled from participants, observers, faculty, and standardized patients.

Results
Participants felt the scenarios were realistic (average rating of 4.7 on a 5-point Likert scale) and improved their practice and preparedness for these situations (average rating, 4.75/5 and 4.18/5, respectively). Our curriculum produced a statistically significant change in participants' pre- and postcurriculum self-reported perceptions of skill (2.42/5 vs. 3.23/5, respectively, P &lt; .001) and level of preparedness (2.91/5 vs. 3.72/5, respectively, P &lt; .001).

Discussion
A simulation-based curriculum using standardized patients, learner-identified needs, 360-degree evaluations, and written feedback demonstrated a statistically significant change in participants' self-perceived skills and preparedness for communicating difficult news in pediatrics.
Feedback Based on Observation of Work Rounds Improves Residents' Self-Reported Teaching Skills
Authors: Chandler Daniel , Snydman Laura K. , Rencic Joseph 
Published: July 2013

Abstract

Introduction
Residents provide a significant amount of bedside teaching to medical students and more junior colleagues, but often do not receive feedback that is tailored to this aspect of their professional performance.

Objective
To assess residents' self-reported improvement in teaching skills after feedback based on direct observation of work rounds.

Method
The authors initiated a program of direct observation of residents' teaching during work rounds during the academic year 2007–2008. Eleven interested faculty volunteers, including chief residents, observed teaching on work rounds by 18 second-year residents in internal medicine during 35 total encounters. Within 24 hours, the faculty observers provided individualized feedback to the resident teachers regarding the quantity and quality of their teaching based on the data collected with the Teaching on Work Rounds observation form. At the end of the year, a survey was conducted to assess the residents' receptivity to this program.

Results
Each observation averaged 92 minutes per observer, for 81.5 recorded hours of observations. Eighty percent of the residents felt that they were better teachers because of the feedback they received, and 87% subsequently reported having made conscious changes in their teaching during work rounds.

Discussion
A direct observation program of residents' teaching on work rounds improved residents' interest in teaching while motivating them to make conscious changes in their teaching based on the individualized feedback they received.
Evaluation of a Faculty Development Program Aimed at Increasing Residents' Active Learning in Lectures
Authors: Desselle Bonnie C. , English Robin , Hescock George , Hauser Andrea , Roy Melissa , Yang Tong , Chauvin Sheila W. 
Published: July 2013

Abstract

Background
Active engagement in the learning process is important to enhance learners' knowledge acquisition and retention and the development of their thinking skills. This study evaluated whether a 1-hour faculty development workshop increased the use of active teaching strategies and enhanced residents' active learning and thinking.

Methods
Faculty teaching in a pediatrics residency participated in a 1-hour workshop (intervention) approximately 1 month before a scheduled lecture. Participants' responses to a preworkshop/postworkshop questionnaire targeted self-efficacy (confidence) for facilitating active learning and thinking and providing feedback about workshop quality. Trained observers assessed each lecture (3-month baseline phase and 3-month intervention phase) using an 8-item scale for use of active learning strategies and a 7-item scale for residents' engagement in active learning. Observers also assessed lecturer-resident interactions and the extent to which residents were asked to justify their answers.

Results
Responses to the workshop questionnaire (n  =  32/34; 94%) demonstrated effectiveness and increased confidence. Faculty in the intervention phase demonstrated increased use of interactive teaching strategies for 6 items, with 5 reaching statistical significance (P ≤ .01). Residents' active learning behaviors in lectures were higher in the intervention arm for all 7 items, with 5 reaching statistical significance. Faculty in the intervention group demonstrated increased use of higher-order questioning (P  =  .02) and solicited justifications for answers (P  =  .01).

Conclusion
A 1-hour faculty development program increased faculty use of active learning strategies and residents' engagement in active learning during resident core curriculum lectures.
An Intervention to Improve Ambulatory Care Handoffs at the End of Residency
Authors: Donnelly Michael J. , Clauser Janelle M. , Weissman Neil J. 
Published: July 2013

Abstract

Introduction
The medical literature shows evidence of numerous initiatives to improve inpatient physician handoffs. In contrast, handoffs of ambulatory patients to incoming interns or junior residents at the end of residency are an area of potential concern that has been overlooked.

Objectives
To examine handoffs of high-risk ambulatory patients by outgoing residents to junior colleagues and to compare current practice to a standard handoff process. We hypothesized the intervention would lead to increases in the number and quality of ambulatory care handoffs.

Methods
Fourteen graduating internal medicine and combined internal medicine-pediatrics residents who practiced at an academic continuity clinic were randomized to an intervention or a control group. E-mail instructions were sent asking the intervention group to write a handoff note using the clinic's electronic medical record system. The e-mail included a detailed outline of information to incorporate and highlight features of the electronic medical record that would facilitate the process. The handoff notes of the intervention and control group were independently evaluated and scored for quality using a predetermined point system.

Results
Six of the 7 residents (86%) in the intervention group completed 19 handoff notes; none of the residents in the control group completed handoff notes. Most of the handoffs provided a brief paragraph or 2 of background information on the patient and then focused on issues needing short-term follow-up during the coming months.

Conclusions
The standardized handoff process implemented via simple e-mail instructions increased the number of outpatient handoffs at the completion of residency. Further study with a larger number of residents, identification and removal of barriers to the handoff process, and correlation of handoffs to clinical outcomes are key next steps.
Avatar-Mediated Home Safety Assessments: Piloting a Virtual Objective Structured Clinical Examination Station
Authors: Andrade Allen D. , Cifuentes Pedro , Oliveira Marcelo C. , Anam Ramanakumar , Roos Bernard A. , Ruiz Jorge G. 
Published: July 2013

Abstract

Background
Avatars and virtual worlds offer medical educators new approaches to assess learners' competency in home-safety assessments that are less time-consuming and more flexible than traditional home visits. We sought to evaluate the feasibility and acceptability of implementing an avatar-mediated, 3-dimensional (3-D) home simulation as a virtual objective structured clinical examination station for geriatric medicine fellows.

Methods
We developed a 3-D home simulation in the virtual world Second Life (Linden Lab, San Francisco, CA) containing 50 safety hazards that could affect the safety of an elderly person at home. Eight geriatric medicine fellows participated in a 16-station objective structured clinical examination, with one station assigned to the 15-minute 3-D virtual world simulation, where the fellow's “home visit” was performed by navigating his or her avatar in the virtual world simulation. The fellows were instructed to find the home safety hazards in the simulated environment and then provide specific written recommendations. Two reviewers independently scored the fellows' written findings against an inventory-based checklist.

Results
The geriatric medicine fellows scored a mean of 43% ± SD 9 on the inventory-based checklist. The scoring of the 2 reviewers showed a high interrater reliability (88%). Six of the 8 participants (75%) rated the simulation as “excellent.” Four of the 5 women (80%) and none of the 3 men (20%) participating in the virtual objective structured clinical examination needed navigation assistance in the 3-D virtual house.

Conclusion
The 3-D, avatar-based, virtual geriatric home safety objective structured clinical examination is a practical and acceptable alternative to the traditional home safety visits in an objective structured clinical examination setting.
A Thematic Review of Resident Commentary on Duty Hours and Supervision Regulations
Authors: Drolet Brian C. , Soh Ina Y. , Shultz Paul A. , Fischer Staci A. 
Published: July 2013

Abstract

Background
The implementation on July 1, 2011, of new Accreditation Council for Graduate Medical Education (ACGME) standards for resident supervision and duty hours has prompted considerable debate about the potential positive and negative effects of these changes on patient care and resident education. A recent large-sample study analyzed resident responses to these changes, using a Likert scale response. In this same study, 874 residents also provided free-text comments, which provide added insight into resident perspectives on duty hours and supervision.

Methods
A mixed-methods quantitative and qualitative survey of residents was conducted in August 2010 to assess resident perceptions of the proposed ACGME regulations. Common concerns in the residents' free responses were synthesized and quantified using content analysis, a common method for qualitative research.

Results
A total of 11 617 residents received the survey. Completed surveys were received from 2561 residents (22.0%), with 874 residents (34.1%) providing free-text responses. Most residents (83.0%) expressed unfavorable opinions about the new standards. The most frequently cited concerns included coverage issues, and a negative impact on patient care and education, as well as lack of preparation for senior roles. A smaller portion of residents commented they thought the standards would contribute to improvements in quality of life (36.1%) and patient care (4.9%).

Conclusions
ACGME standards are important for graduate medical education, and their aim is to promote high-quality education and better care to patients in teaching institutions. Yet, many residents are concerned about the day-to-day impact of the 2011 regulations, in particular the 16-hour duty period for interns. Most residents who provided free-text responses had a negative impression of the new ACGME regulations. Residents' resistance to duty hour changes may represent a realization that residents are losing a central role in patient care. The concerns identified in this study demonstrate important issues for administrators and policymakers. Resident ideas and opinions should be considered in future revisions of ACGME requirements.
The Women in Emergency Medicine Mentoring Program: An Innovative Approach to Mentoring
Authors: Welch Julie L. , Jimenez Heather L. , Walthall Jennifer , Allen Sheryl E. 
Published: July 2013

AbstractBackgroundWomen in medicine report many gender-specific barriers to their career success and satisfaction, including a lack of mentors and role models. The literature calls for innovative strategies to enhance mentorship for women in medicine.ObjectiveTo describe the content, perceived value, and ongoing achievements of a mentoring program for women in emergency medicine.MethodsThe program offered mentoring for female faculty and residents in an academic emergency medicine department. Volunteers participated in group mentoring sessions using a mosaic of vertical and peer mentoring. Sessions focused on topics specific to women in medicine. An anonymous, electronic survey was sent to women who participated during 2004–2010 to assess the perceived value of the program and to collect qualitative feedback. Preliminary achievements fulfilling the program's goals were tracked.ResultsA total of 46 women (64%) completed the survey. The results showed a positive perceived value of the program (average, 4.65 on a 5-point Likert scale) in providing mentors and role models (4.41), in offering a supportive environment (4.39), in providing discussions pertinent to both personal (4.22) and professional development (4.22), while expanding networking opportunities (4.07). Notable achievements included work on the creation of a family leave policy, establishing lactation space, collaboration on projects, awards, and academic advancement.ConclusionThis innovative model for mentoring women is perceived as a valuable asset to the academic department and residency. It offers the unique combination of expanding a female mentor pool by recruiting alumni and using a mosaic of vertical and peer mentoring.
Impact of an Anesthesiology Rotation on Subsequent Endotracheal Intubation Success
Authors: Clark Ted R. , Brizendine Edward J. , Milbrandt Joseph C. , Rodgers Kevin G. 
Published: July 2013

Abstract

Background
Endotracheal intubation (ETI) is an essential skill that emergency medicine residents learn throughout their training.

Objective
To evaluate the effect of implementing a postgraduate year (PGY)-1 anesthesiology rotation on ETI success in the emergency department during PGY-2.

Methods
Residents in the study group completed a 4-week PGY-1 anesthesiology rotation. During the first 6 months of PGY-2, we compared ETI performance of the study group with a control group who did not experience a PGY-1 anesthesiology rotation. Data recorded included date, level of training, first- and second-attempt success, rescue devices used, major adverse events, and intubation scenario. A Pearson χ2 test was used to compare first-attempt success, overall success (≤2 attempts), and adverse events rates between the 2 groups.

Results
Overall success rate for the study groups was 95.7% (111 of 116), compared with 94.5% (137 of 145) for the controls (P  =  66). First-attempt success for the study group was 78.4% (91 of 116), compared with 83.4% (121 of 145) for the control group; this was not statistically significant (P  = .30). Observed major and minor adverse events were similar: 19.0% for the study group (22 of 116) versus 24.8% (36 of 145) for the control group (P  = .26).

Conclusions
The addition of an anesthesiology rotation to the PGY-1 curriculum did not have a significant effect on ETI success or the rate of adverse events during the first 6 months of PGY-2. First-attempt overall success and adverse events of our PGY-2 study group were consistent with previously published studies.
Optimizing the Implementation of Practice Improvement Modules in Training: Lessons from Educators
Authors: Bernabeo Elizabeth , Hood Sarah , Iobst William , Holmboe Eric , Caverzagie Kelly 
Published: July 2013

Abstract

Background
The American Board of Internal Medicine approved the use of Practice Improvement Modules (PIMs) to help training programs teach and assess practice-based learning and improvement (PBLI) and systems-based practice (SBP).

Methods
We surveyed individuals who ordered a PIM in a residency or fellowship training program between June 2006 and August 2009. The 43 programs that volunteered to participate completed a 30-minute anonymous online survey.

Results
Program directors or associate program directors led the PIM process in 30 programs (70%). Trainees' degrees of involvement in PIMs were highly variable between programs, and several respondents felt that trainees were either not sufficiently engaged or not engaged with enough consistency. The most common activity for trainee involvement was data collection through patient surveys or chart review, although only 17 programs (40%) provided protected time for this activity. Few trainees participated in higher level activities such as data analysis or identification for areas of improvement or were given leadership roles; yet most respondents reported that completing the PIM helped trainees learn basic principles of QI and develop competence in PBLI and SBP and that PIM completion improved the program's ability to develop QI initiatives and resulted in program or institutional improvements, including sustainable improvement in patient care. Most respondents reported that the outcome warranted the effort to complete PIMs.

Conclusions
PIMs may be a valuable but underused educational experience for trainees as well as training programs. Focusing on particular themes and facets of PIMs may facilitate implementation.