bluuebunny/crossref_metadata_2025_split huggingface dataset:
Giving Feedback on Clinical Skills: Are We Starving Our Young?
Authors: Anderson Peter A. M. 
Published: July 2013

Abstract

Background
Feedback to clinical learners about their performance is crucial to their development into competent clinicians. Most feedback is provided by clinicians who have little or no formal training for this aspect of their teaching role.

Method
Narrative review.

Findings
Feedback is most effective if provided by clinical mentors based on observations of behavior, with emphasis on correctable deficiencies. The difference between feedback, which is formative, and evaluation, which is summative, needs to be understood by both the giver and receiver. The ability to self-assess is an important related concept, with studies showing that self-assessment skills are lowest in individuals found to be the least competent in external assessments and in individuals with a high level of confidence.

Conclusions
Feedback is an important component in learners' development, and clinical faculty should be educated about the importance of providing feedback, and the means to do so effectively must be provided to them. Despite several decades of accumulated knowledge in this area, the evidence from learners is that we continue to starve them of this critical nutrient for their growth.
Reflection in a Museum Setting: The Personal Responses Tour
Authors: Gaufberg Elizabeth , Williams Ray 
Published: July 2013

Abstract

Introduction
We describe an educational innovation piloted by the director of education at a university art museum and a physician-educator using the museum holdings as reflective triggers for medical learners. This innovation is distinct from the emerging trend of using art to build observation skills, enhance pattern recognition, and improve diagnostic acumen. Our intervention is specifically designed to promote individual reflection, foster empathy, increase appreciation for the psychosocial context of patient experience, and create a safe haven for learners to deepen their relationships with one another.

Methods
Individuals randomly selected a question from a set prepared by the authors to guide a reflective exploration of the galleries. Each question was different, but all invited an emotional response—a connection between a work of art and some aspect of life or medical practice, for example, “Focus on a memorable patient, and find a work of art that person would find meaningful or powerful” or “Find an image of a person with whom you have difficulty empathizing.” The exploration ended with a shared tour of evocative objects selected by the participants. The duration of the exercise was approximately 1.5 hours and required minimal faculty preparation.

Results
Most of the participants rated the exercise as 5 (excellent) on a 5-point Likert scale and particularly cited the effectiveness at stimulating reflection on meaningful issues and community building.

Discussion
The exercise is easily reproducible in any art gallery space. The same basic format and facilitation technique opens new and different conversations depending on the composition of the group and the choice of artwork. Museum-based reflection warrants further experimentation, analysis, and dissemination.
A New Tool for Testing and Training Ophthalmoscopic Skills
Authors: McCarthy Danielle M. , Leonard Heather R. , Vozenilek John A. 
Published: July 2013

Abstract

Introduction
The direct fundoscopic examination is an important clinical skill, yet the examination is difficult to teach and competency is difficult to assess. Currently there is no defined proficiency assessment for this physical examination, and the objective of this study was to assess the feasibility of a simulation model for evaluating the fundoscopic skills of residents.

Methods
Emergency medicine and ophthalmology residents participated in simulation sessions using a commercially available eye simulator that was modified with customized slides. The slides were designed with the goal of having a quantifiable measure of visualization in addition to a more traditional descriptive outcome. To assess feasibility, participants' ease of use, time to perform the examination, and user satisfaction were assessed.

Results
The simulation could be completed in a timely fashion (mean time per slide, 61–95 seconds), and there were no significant differences in performance between emergency medicine and ophthalmology residents in completion of this task. Residents expressed an interest in fundoscopy through simulation but found this model technically challenging.

Conclusions
This simulation model has potential as a means of training and testing fundoscopy. A concern was low user satisfaction, and further refinement of the model is needed.
An Interactive Handoff Workshop to Improve Intern Readiness in Patient Care Transitions
Authors: Aylward Michael , Vawter Lemuel , Roth Craig 
Published: July 2013

Abstract

Introduction
Patient handoffs are common during residency and are often performed with little or no training. We devised a simple intervention to improve the readiness of interns to perform handoffs.

Methods
We administered a 90-minute interactive workshop during intern orientation in 2009 and 2010. It consisted of a discussion, a case presentation, and a trigger video, followed by debriefing and a role-play exercise. The workshop required minimal technology and materials. Interns were surveyed on their readiness to perform handoffs before and after the workshop as well as 3 to 6 months after the workshop.

Results
Eighty-nine interns participated in the workshop during a 2-year period. Seventy-four survey responses were collected. Self-reported readiness to perform a handoff increased by 26%. A total of 91% and 81% of respondents in 2010 and 2009, respectively, reported using aspects of the workshop up to 6 months later.

Conclusion
A brief workshop can improve interns' readiness to perform handoffs.
Relationship Between Time of First Publication and Subsequent Publication Success Among Non-PhD Physician-Scientists
Authors: Riggs Kevin R. , Reitman Zachary J. , Mielenz Thelma J. , Goodman Philip C. 
Published: July 2013

Abstract

Background
Studies have shown that publication of work during medical school and residency is associated with higher numbers of later publications and citations of published research. However, it is unknown whether this association exists for non-PhD physician-scientists and whether the association persists later into their careers.

Methods
We extracted publication records from the curricula vitae (CVs) of 102 corresponding authors of articles published in 2008 in the New England Journal of Medicine and JAMA, and obtained those authors' citation records from Web of Science. We used regression models to examine the association between time of first publication and later publication and citation rates for the entire postgraduate career and a recent 2-year period.

Results
After adjusting for time since medical school graduation, sex, location of medical school (United States or not United States), and additional non-PhD degrees, we found that authors who first published before graduating from medical school had a greater mean number of publications after medical school and during the period from 2006 to 2007 (164 and 28, respectively) than those who first published during the 5 years afterward (111 and 19, respectively) and those who first published more than 5 years after graduation (59 and 13, respectively). Similarly, authors who first published before graduating from medical school had a greater mean number of citations of their published work since graduation and of publications from 2006 to 2007 (4634 and 333, respectively) than those who first published during the 5 years afterward (2936 and 183, respectively) and those who first published more than 5 years after graduation (1512 and 143, respectively).

Conclusions
Early publication is associated with higher numbers of publications and more citations of published research among non-PhD physician-scientists. This association persists well into a researcher's career.
Why Residents Consider Working Beyond the Duty Hour Limits: Implications of the ACGME 2011 Duty Hour Standards
Authors: Fletcher Kathlyn E. , Nickoloff Sarah , Whittle Jeff , Jackson Jeffrey L. , Frank Michael , Schapira Marilyn M. 
Published: July 2013

Abstract

Background
The Accreditation Council for Graduate Medical Education 2011 duty hour standards became effective on July 1, 2011. One of the new standards allows residents to exceed the limit on continuous duty hours in unusual circumstances relating to patient or family need or rare educational opportunities. There are no data about how often or in what circumstances residents would consider exceeding their duty hour limits using this new provision in the standards. We surveyed internal medicine residents to explore these questions.

Methods
We conducted an anonymous cross-sectional survey of internal medicine residents at a midwestern tertiary-care hospital to determine how often they had considered exceeding duty hour limits in the preceding 2 weeks. We analyzed responses using descriptive statistics and χ2 tests for comparisons.

Results
We obtained responses from 51 of 86 residents (59%). Of those residents, 69% (35/51) indicated that they had wanted to exceed duty hour limits at least once in the prior 2 weeks. The most common reason cited was to provide continuity of care for a patient. The 24 + 6–hour rule was the standard most likely to be broken (cited by 66%; 23/35).

Conclusions
Program leadership should anticipate that residents will commonly identify situations in which they will consider exceeding duty hour limits. It will be important to provide guidance to residents early in the year about the situations that would be appropriate for the application of this new standard.
To Match or Not: Factors Influencing Resident Choice of Graduate Medical Education Program
Authors: Nagler Alisa , Andolsek Kathryn , Schlueter Joanne , Weinerth John 
Published: July 2013

Abstract

Background
Little is known about the factors that influence applicants' decisions to select a graduate medical education training program. Programs may improve their recruitment by better understanding that process.

Methods
Following the Match for the years 2008 though 2010, an electronic survey was sent to 664 applicants to 15 Duke University graduate medical education programs. Those individuals were ranked high enough to match to Duke University but chose to match at another institution. We used quantitative and qualitative analyses to explore factors influencing candidates' decisions and to identify program and institutional improvements to better attract top candidates.

Results
Response rate was 63% (417/664). The quantitative analysis identified factors that were “very important” to applicants (current resident satisfaction, relationship between faculty and residents, collegiality of current residents, quantity and quality of faculty content/mentoring, faculty teaching expertise, diversity of patients and types of procedures, and location), and those that were “not important” to applicants (child care or education opportunities for children, salary, United States Medical Licensing Examination requirements, part-time training options, favorable environment for minorities or women). There were statistically significant differences among specialties. Qualitative analysis identified 3 themes as most influential in their choice: location, program relationships, and the interview experience.

Conclusion
The collection of 3 years of data across specialties identified factors that are important to applicants' choice of a training program. Some factors can be addressed quickly and with little effort, such as the format of the interview day. Others require programs and institutions to revisit their mission, priorities, and training culture to improve relationships between residents and faculty. Programs may wish to be more tactical in selecting the residents and faculty who meet with applicants and be more focused in planning how the interview time is used.
Toward “The Genius of the AND”: Balancing Professionalism and Duty Hour Requirements in Graduate Medical Education
Authors: Stoller James K , Isaacson J. Harry , Nielsen Craig 
Published: July 2013

Abstract
Although enhancing professionalism and ensuring compliance with duty hour regulations both represent important priorities of current graduate medical education, tension in reconciling these goals has been expressed. The term tyranny of the OR has been coined to express the assumption of dichotomous thinking, that is, that we assume we must choose between seemingly competing goals. In contrast, because there is powerful creative value in adopting a bridging mindset, an alternative state called the genius of the AND has been defined to express the benefits of reconciling perceived competing goals.
An Alumni Survey as a Needs Assessment for Curriculum Improvement in Obstetrics and Gynecology
Authors: Curran Diana , Xu Xiao , Dewald Samantha , Johnson Timothy R. B. , Reynolds R. Kevin 
Published: July 2013

AbstractBackgroundThe Accreditation Council for Graduate Medical Education requirements recommend using outside measures to perform annual residency program evaluations to identify areas for program improvement.ObjectiveThe aim of the study was to identify areas for residency program improvement via an alumni survey.MethodsAn anonymous online survey was sent to the last 10 years of graduates from our obstetrics and gynecology residency program.ResultsResponse rate was 63% (34 of 54). All respondents reported being comfortable serving as gynecologic consultants. More than 75% (26 of 54) reported being comfortable performing abdominal hysterectomies, vaginal hysterectomies, basic and complex laparoscopies, and vaginal surgery. Regarding management of urologic injuries, the participants' responses varied, with 58% (20 of 34) reporting they felt prepared, 21% (7 of 34) with neutral responses, and 21% (7 of 34) reporting they felt unprepared. For total laparoscopic hysterectomy, 65% (22 of 34) reported feeling prepared, 29% (10 of 34) reported they felt unprepared, and 9% (3 of 34) reported they felt neutral. All respondents indicated that he or she would still choose the obstetrics and gynecology residency program at the University of Michigan.ConclusionAn alumni survey can provide useful outside measures for training programs to assess their effectiveness in preparing their graduates for independent practice. Results of alumni surveys can provide a blueprint for program improvement.
Baseline Sleep Dysfunction Among Matriculating Interns
Authors: Pulliam Samantha J. , Weinstein Debra F. , Malhotra Atul , Macklin Eric A. , Berkowitz Lori R. 
Published: July 2013

Abstract

Background
Work hour limitations for graduate medical trainees, motivated by concerns about patient safety, quality of care, and trainee well-being, continue to generate controversy. Little information about sleep habits and the prevalence of sleep disorders among residents is available to inform policy in this area.

Objectives
To evaluate the sleep habits of matriculating residents, postgraduate year-1 (PGY-1).

Design
An anonymous, voluntary, self-administered survey study was used with 3 validated questionnaires: the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, and the Epworth Sleepiness Scale, which were fielded to PGY-1 residents entering the Accreditation Council for Graduate Medical Education–accredited programs at Massachusetts General Hospital and/or Brigham and Women's Hospitals in June and July 2009.

Results
Of 355 eligible subjects, 310 (87%) participated. Mean sleep time for PGY-1 residents was 7 hours and 34 minutes, and 5.6% of PGY-1 residents had Pittsburgh Sleep Quality Index global scores greater than 5, indicating poor quality sleep. Using multiple linear and ordinal logistic regression models, men had higher Pittsburgh Sleep Quality Index sleep latency scores, whereas women and those with children had higher Epworth Sleepiness Scale daytime sleepiness scores, and 18% of PGY-1 residents had abnormal amounts of daytime sleepiness based on the Epworth Sleepiness Scale. The Insomnia Severity Index identified 4.2% of PGY-1 residents with moderate insomnia.

Conclusions
Some PGY-1 residents may begin residency with sleep dysfunctions. Efforts to provide targeted help to selected trainees in managing fatigue during residency should be investigated.
Implementing a Multifaceted Quality-Improvement Curriculum in an Obstetrics-Gynecology Resident Continuity-Clinic Setting: A 4-Year Experience
Authors: Sepulveda Debra , Varaklis Kalli 
Published: July 2013

Abstract

Background
Although many residency programs are instituting quality improvement (QI) curricula in response to both institutional and external mandates, there are few reports of successful integration of resident initiated projects into these QI curricula with documented impact on health care processes and measures.

Intervention
We introduced a multifaceted curriculum into an Obstetrics-Gynecology continuity clinic. Following a needs assessment, we developed a didactic session to introduce residents to QI tools and the how to of a mentored resident-initiated project. Resident projects were presented to peers and faculty and were evaluated. A postgraduation survey assessed residents' satisfaction with the curriculum and preparedness for involvement in QI initiatives after residency. We also assessed whether this resulted in sustained improvement in health care measures.

Results
The curriculum was presented to 7 classes of residents (n  =  25) and 17 resident initiated projects have been completed. Twenty-one residents (84%) completed the preintervention survey and 12 of 17 (71%) residents who completed the entire curriculum completed the postintervention survey. Sustained change in surrogate health measures was documented for 4 projects focused on improving clinical measures, and improvement in clinical systems was sustained in 9 of the remaining 13 projects (69%). Most of the respondents (75%, n  =  9) agreed or strongly agreed that the projects done in residency provided a helpful foundation to their current QI efforts.

Conclusion
This project successfully demonstrates that a multifaceted program in QI education can be implemented in a busy Obstetrics-Gynecology residency program, resulting in sustained improvement in surrogate health measures and in clinical systems. A longitudinal model for resident projects results in an opportunity for reflection, project revision, and a maintenance plan for continued clinical impact.
The Radar Graph: the Development of an Educational Tool to Demonstrate Resident Competency
Authors: Keister Drew M. , Larson Daniel , Dostal Julie , Baglia Jay 
Published: July 2013

Abstract

Background
Despite the movement toward competency-based assessment by accrediting bodies in recent years, there is no consensus on how to best assess medical competence. Direct observation is a useful tool. At the same time, a comprehensive assessment system based on direct observation has been difficult to develop.

Intervention
We developed a system that translates data obtained from checklists of observed behaviors completed during educational activities, including direct observation of clinical care, into a graphic tool (the “radar graph”) usable for both formative and summative assessment. Using unique, observable behaviors to evaluate levels of competency on the Dreyfus scale, we assessed resident performance in 6 learning sites within our residency. Data are represented on a radar graph, which residents and faculty used to recognize both strengths and areas for growth to guide educational planning for the individual learner.

Results
Initial data show that the radar graphs have construct validity because the development process accurately reflects the desired construct, assessors were adequately trained, and the radar graphs demonstrated resident growth over time. A form completion rate of 90% for &gt;1500 disseminated assessments suggests the feasibility of our process.

Conclusions
The radar graph is a promising tool for use in resident feedback and competency assessment. Further research is needed to determine the full utility of the radar graphs, including a better understanding of the tool's reliability and construct validity.
Results From a Transitional-Year Program Director Survey: Identifying Crucial Issues and Concerns
Authors: Craig Steven R. , Smith Hayden L. , Short Matthew W. 
Published: July 2013

Abstract

Background
Transitional Year (TY) programs meet an important need by preparing residents for specialties that accept individuals after an initial preparatory year. To our knowledge, no surveys to date have been conducted to identify attributes of TY programs and concerns of TY program directors.

Purpose
The purpose of this study was to review TY program characteristics and identify critical issues and concerns of TY program directors (TYPDs).

Methods
A web-based, 22-question survey was sent to all 114 TYPDs of programs accredited by the Accreditation Council for Graduate Medical Education between January and April 2011. The survey included open-formatted and closed-formatted questions addressing program and institution demographics, program director time, administrative support, satisfaction, and future plans.

Results
The survey response rate was 86%. The median age of TY programs was 28 years, with few new programs. More than 80% of TY programs were conducted at community hospitals and university-affiliated community hospitals. Of the responding TYPDs, 17% had served less than 2 years, and 32% had served 10 years or more. Common sponsoring TY programs included internal medicine (88%), general surgery (42%), family medicine (25%), emergency medicine (24%), and pediatrics (18%). Overall, TYPDs were satisfied with their positions. They expressed concerns about inadequate time to complete duties, salary support, and administrative duties assigned to program coordinators. Forty-nine percent of TYPDs reported they planned to leave the position within the next 5 years.

Conclusions
Our survey provides useful information to assist institutions and the graduate medical education community in meeting the needs of TYPDs and strengthening TY programs.