bluuebunny/crossref_metadata_2025_split huggingface dataset:
Les entraves au bien-être du personnel des grands magasins : pistes de solutions
Authors: Barel Yvan , Frémeaux Sandrine 
Published: July 2013

Michel est chef de rayon depuis 10 ans dans un supermarché de la banlieue parisienne. Enthousiaste lors de sa prise de fonction, il semble aujourd’hui usé par son travail, même s’il ne se plaint pas, parce que, pour lui, « un bon chef doit toujours se montrer fort ». Il sait que pour garder son poste, il doit réaliser un bon chiffre d’affaires et des bénéfices élevés. Mais la tâche est de plus en plus ardue et sa marge de manœuvre se trouve réduite. Les décisions commerciales sont désormais centralisées au siège social. On l’oblige aussi à diminuer les frais de personnel. En conséquence, il exerce une pression sur ses collaborateurs, qui doivent sans cesse augmenter leur rendement. Les rapports de travail sont tendus. Pourtant, il existe des solutions à cette problématique. Cet article vise à comprendre les menaces qui pèsent sur le bien-être des chefs de rayon et des employés des supermarchés afin de mieux prévenir les problèmes et intervenir face à ceux-ci.
Institutional Attributes Associated With Innovation and Improvement: Results of a Multisite Study
Authors: Philibert Ingrid , Johnston Mary Joyce , Hruska Laura , Shapiro Jane A. , Friedmann Paul , Gardent Paul B. , Batalden Paul B. , Leach David C. 
Published: July 2013

Abstract

Background
To date, no studies have explored why some teaching hospitals and health systems appear to offer a more fertile environment for innovation and improvement in the learning environment. As a consequence, little is known about the role of organizational attributes and culture in fostering innovation and improvements in settings where residents learn and participate in care, though these have been studied extensively in the general literature on organizations.

Aims
The goals of our study entailed (1) gathering ground-level observations on processes and common attributes; (2) disseminating this information for adoption and adaptation; and (3) exploring whether the current accreditation model may present barriers to institution- and program-level innovation.

Methods
We conducted a qualitative study of 4 institutions, successful in innovation and improvement in their learning environment, and sought to replicate the findings with a second group of 5 institutions.

Results
Three themes emerged from the interviews and site visits of the participants in the alpha phase: (1) a structure and culture that promote integration and inclusion; (2) a recognition of the value of resident education to the institution; and (3) a learning organization rooted in the extensive use of data and ongoing change, improvement, and innovation.

Conclusions
Some of the concepts identified in our small sample of “innovative” institutions could be relatively easily adopted or adapted by others that seek to enhance innovation and improvement in the learning environment. In contrast, the structural factors that characterized 3 of the 4 alpha participants, particularly the organization and compensation of faculty, may not be generalizable to many other institutions.
Residency Programs' Evaluations of the Competencies: Data Provided to the ACGME About Types of Assessments Used by Programs
Authors: Holt Kathleen D. , Miller Rebecca S. , Nasca Thomas J. 
Published: July 2013

Abstract

Background
In 1999, the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project began to focus on resident performance in the 6 competencies of patient care, medical knowledge, professionalism, practice-based learning and improvement, interpersonal communication skills, and professionalism. Beginning in 2007, the ACGME began collecting information on how programs assess these competencies. This report provides information on the nature and extent of those assessments.

Methods
Using data collected by the ACGME for site visits, we use descriptive statistics and percentages to describe the number and type of methods and assessors accredited programs (n  =  4417) report using to assess the competencies. Observed differences among specialties, methodologies, and assessors are tested with analysis of variance procedures.

Results
Almost all (&gt;97%) of programs report assessing all of the competencies and using multiple methods and multiple assessors. Similar assessment methods and evaluator types were consistently used across the 6 competencies. However, there were some differences in the use of patient and family as assessors: Primary care and ambulatory specialties used these to a greater extent than other specialties.

Conclusion
Residency programs are emphasizing the competencies in their evaluation of residents. Understanding the scope of evaluation methodologies that programs use in resident assessment is important for both the profession and the public, so that together we may monitor continuing improvement in US graduate medical education.
Internal Medicine Residents' Acceptance of Self-Directed Learning Plans at the Point of Care
Authors: Smith Susan J , Kakarala Radhika R , Talluri Siva K , Sud Parul , Parboosingh J 
Published: July 2013

Abstract

Objectives
We implemented a curriculum using self-directed learning plans (SDLPs) based on clinical questions arising from the residents' practice, and we report on perceptions and attitudes from residents in internal medicine regarding the use of SDLPs conceived at point of care.

Methods
Internal medicine residents at a single community hospital in the Midwest were surveyed in 2006 regarding SDLPs. We report their perceived effectiveness in identifying knowledge gaps, the processes used to fill those gaps, and the resident outcomes using descriptive statistics.

Results
A total of 26 out of 37 residents (70%) responded. Most (24 of 26; 92%) perceived SDLPs helped them to identify and fill knowledge gaps and that their skills in framing questions (23 of 26; 88%), identifying resources (21 of 26; 81%), and critically appraising the evidence (20 of 26; 77%) improved through regular use. They also felt these plans led to a meaningful change in their practice or provided further direction for learning (17 of 26; 65%). Most (21 of 26; 81%) reported their intent to include point-of-care learning in their continuing education after residency. We found no significant differences in the responses of first-year compared with second- or third-year residents.

Conclusions
Questions arising during patient care are strong motivators for physician self-directed learning. The residents' responses indicated that they accepted the SDLPs and intend to use them in practice. Embedding the discussion of the SDLPs in preclinic conferences has ensured sustainability during the past 5 years and has enabled us to demonstrate teaching of practice-based learning and improvement.
Opportunities in Global Health Education: A Survey of the Virtual Landscape
Authors: Castillo Jonathan , Castillo Heidi , DeWitt Thomas G 
Published: July 2013

Abstract

Background
A new generation of medical students is seeking residency programs offering global health education (GHE), and there is growing awareness of the benefits this training provides. However, basic factors that have an impact on its implementation and its effect on the residency match are insufficiently understood. The purpose of this study was to explore the extent of online information on GHE available to potential US pediatric residency program applicants.

Methods
Pediatric residency programs' websites were systematically examined in 2007, 2008, and 2009 to extract available information on GHE.

Results
In 2007, 147 websites (76.2%) had no information available on GHE; 40 (20.7%) mentioned international opportunities; and 6 (3.1%) provided evidence of a global health track or program. In 2008, 123 websites (63.1%) had no information available on GHE; 57 (29.2%) mentioned international opportunities; and 15 (7.7%) had a formal program. In 2009, 105 websites (53.6%) had no information available on GHE; 70 (35.7%) mentioned international opportunities; and 21 (10.7%) had a formal program. Between 2007 and 2009, the percentage of pediatric residency programs with information on GHE available nearly doubled from 23.8% to 46.4%. Within the same period, the number of formal GHE programs offered more than tripled.

Conclusions
By the 2009–2010 academic year, the websites for nearly half of the residency programs mentioned international experiences, yet only a small number of these residencies appeared to have developed a formal GHE program. Further, the websites for many residency programs did not include information on the international opportunities they offered, with programs running the risk of failing to attract and ultimately match global health–minded applicants.
A Pilot Study of a “Resident Educator And Life-long Learner” Program: Using a Faculty Train-the-Trainer Program
Authors: Pien Lily C , Taylor Christine A , Traboulsi Elias , Nielsen Craig A 
Published: July 2013

Abstract

Purpose
We sought to create a resident educator program using a Train-the-Trainer (TTT) approach with adaptable curricula at a large tertiary health care center with a medical school and 60 accredited residency programs.

Methods
The Resident Educator And Life-long Learner (REALL) Program was designed as a 3-phase model. Phase 1 included centralized planning and development that led to the design of 7 teaching modules and evaluation tools for TTT and resident sessions. Phase 2 entailed the dissemination of the TTT modules (Learning Styles, Observational Skills, Giving Feedback, Communication Skills: The Angry Patient, Case-Based Teaching, Clinical Reasoning, Effective Presentations) to faculty trainers. In phase 3, specific modules were chosen and customized by the faculty trainers, and implemented for their residents. Evaluations from residents and faculty were collected throughout this process.

Results
A total of 45 faculty trainers representing 27 residency programs participated in the TTT program, and 97% of trainers were confident in their ability to implement sessions for their residents. A total of 20 trainers from 11 residency programs implemented 33 modules to train 479 residents, and 97% of residents believed they would be able to apply the skills learned. Residents' comments revealed appreciation of discussion of their roles as teachers.

Conclusion
Use of an internal TTT program can be a strategy for dissemination of resident educator and life-long learner curricula in a large academic tertiary care center. The TTT model may be useful to other large academic centers.
The Intersection Between Clinical Excellence and Role Modeling in Medicine
Authors: Kravet Steven J. , Christmas Colleen , Durso Samuel , Parson Gregory , Burkhart Kathleen , Wright Scott 
Published: July 2013

Abstract

Background
Role modeling is an integral component of medical education. The literature suggests that being a clinically excellent academic physician and serving as a role model for trainees are integrally related.

Purpose
To explore the relationship between being considered clinically excellent and being considered an effective role model.

Methods
Two independent surveys were administered to clinically active faculty (asked to name clinically excellent colleagues) and internal medicine residents (asked to name faculty role models). We compared frequency counts of clinically excellent faculty mentioned and frequency counts of role models mentioned by respondents. Spearman correlations and odds ratios with 95% confidence intervals were used to assess the relationship between the responses.

Results
A total of 39 of 66 faculty (59%) and 45 of 50 residents (90%) responded. There were 31 faculty members judged to be clinically excellent and 67 faculty identified as role models. Thirty faculty members appeared on both lists. There was a moderately high correlation between these groups (Spearman correlation coefficient  =  0.54, P &lt; .001). Faculty members who were among those named as clinically excellent by their peers were more likely to be named 3 or more times as a role model by trainees (odds ratio, 24.6; confidence interval, 2.9–207).

Conclusions
This study tested and confirmed the correlation between clinical excellence and role modeling, illustrating the value of these faculty members at teaching hospitals.
Integrative Medicine in Residency Education: Developing Competency Through Online Curriculum Training
Authors: Lebensohn Patricia , Kligler Benjamin , Dodds Sally , Schneider Craig , Sroka Selma , Benn Rita , Cook Paula , Guerrera Mary , Dog Tieraona Low , Sierpina Victor , Teets Raymond , Waxman Dael , Woytowicz John , Weil Andrew , Maizes Victoria 
Published: July 2013

Abstract

Introduction
The Integrative Medicine in Residency (IMR) program, a 200-hour Internet-based, collaborative educational initiative was implemented in 8 family medicine residency programs and has shown a potential to serve as a national model for incorporating training in integrative/complementary/alternative medicine in graduate medical education.

Intervention
The curriculum content was designed based on a needs assessment and a set of competencies for graduate medical education developed following the Accreditation Council for Graduate Medical Education outcome project guidelines. The content was delivered through distributed online learning and included onsite activities. A modular format allowed for a flexible implementation in different residency settings.

Evaluation
To assess the feasibility of implementing the curriculum, a multimodal evaluation was utilized, including: (1) residents' evaluation of the curriculum; (2) residents' competencies evaluation through medical knowledge testing, self-assessment, direct observations, and reflections; and (3) residents' wellness and well-being through behavioral assessments.

Results
The class of 2011 (n  =  61) had a high rate of curriculum completion in the first and second year (98.7% and 84.2%) and course evaluations on meeting objectives, clinical utility, and functioning of the technology were highly rated. There was a statistically significant improvement in medical knowledge test scores for questions aligned with content for both the PGY-1 and PGY-2 courses.

Conclusions
The IMR program is an advance in the national effort to make training in integrative medicine available to physicians on a broad scale and is a success in terms of online education. Evaluation suggests that this program is feasible for implementation and acceptable to residents despite the many pressures of residency.
An Institutional Approach to Assist Program Directors and Coordinators With Meeting the Challenges of Graduate Medical Education
Authors: Cottrell Scott , Brownlee Lori , Ferrari Norman 
Published: July 2013

Abstract

Objective
To investigate whether a multimethod approach, including a new position dedicated to graduate medical education (GME) educator, online education modules, and program file audits, was associated with quality improvement in our residency programs.

Method
Data related to GME audits, residency review committee citations and cycle lengths were entered into a database. We conducted statistical analyses and calculated effect sizes to explore whether these resources were associated with program quality, as measured by maintaining necessary program policies and files, implementation of multiple assessments, increased residency review committee cycle lengths, and reductions in the number of citations.

Results
The statistical analyses support the implementation of the GME educator, file audits, and online courses designed to improve the quality of residency education.

Conclusions
The GME office will continue to conduct audits, develop online learning resources, and provide one-on-one communication between the GME educator and program coordinators and directors. Our approach could serve as a model for other institutions interested in enhancing institutional oversight and the quality of their programs.
Women's Health Curriculum for Internal Medicine Residents: Development, Implementation, and Evaluation
Authors: Davisson Laura , Nuss Michelle , Cottrell Scott 
Published: July 2013

Abstract

Objective
Women's health knowledge and skills are important for physicians, but training is often inadequate. The objective of this project was to develop, implement, and evaluate a women's health curriculum for an internal medicine residency program.

Methods
After assessing institutional factors, we developed a curriculum for a multidisciplinary clinical rotation with a web-based tutorial. We recruited faculty from several specialties relevant to the care of women to precept for the rotation and/or to provide teaching materials for the tutorial.

Results
The curriculum for the 1-month rotation covered most of the recommended women's health topics. Internal medicine residents worked in a variety of clinical settings and were assigned to a web-based tutorial and a pretest and posttest. A statistically significant increase was seen in participants' mean posttest (71.7%) versus pretest (61.1%) scores (difference, 10.7%; 95% confidence interval [CI]: 4.7–16.6; P  =  .0009). No difference was seen in controls' mean posttest (56.5%) versus pretest (57.2%) scores (difference, −0.7%; 95% CI: −12.1–10.7; P  =  .9). Mean rotation evaluation responses ranged from 7.09 to 7.45 on a 9-point scale. The majority (93%) of survey respondents agreed that the rotation increased their skills in caring for women, and all agreed the program was well organized and that it increased their awareness of women's health issues.

Conclusion
A women's health curriculum using a web-based tutorial with a multidisciplinary clinical rotation can be successfully implemented in an internal medicine residency. The curriculum satisfied women's health training requirements, was associated with improvements in learning outcomes, and may be a model for women's health education.
Teaching Systems-Based Competency in Anesthesiology Residency: Development of an Education and Assessment Tool
Authors: Soto Roy G. , Cormican Daniel S. , Gallagher Christopher J. , Seidman Peggy A. 
Published: July 2013

Abstract

Background
The Accreditation Council for Graduate Medical Education requires programs to educate and evaluate residents in 6 competencies, including systems-based practice. We designed a survey and assessment tool to address the competency as it pertains to anesthetic drug costs in an academic center.

Methods
Residents, certified registered nurse anesthetists, and faculty were asked to complete an anesthetic drug-cost survey without relying on reference materials. After a combination of compulsory in-class didactic sessions and web-based education, the participants were asked to design an anesthetic, give example cases, and determine costs. The initial task was repeated 1 year later.

Results
Our preintervention survey revealed that most practitioners knew very little about anesthetic drug costs, regardless of level of training or degree. All residents completed the mandatory online education tool, more than 80% attended the departmental grand rounds program, and 100% met the goal of designing an anesthetic for all cases within the preset price limit. A repeat of the cost estimate produced an improvement in cost estimates with reduction in variability (P &lt; .05, Student unpaired t test), although estimates of volatile anesthetic and reversal agent costs did not achieve significance at the .05 level for any of the 3 cases.

Conclusion
Introducing a formalized teaching and assessment tool has improved our residents' understanding of anesthetic drug costs, and improved our ability to teach and assess the systems-based practice competency.
Mentoring for Subspecialty Training Program Directors: An Unrecognized, Unmet Need?
Authors: Norby Suzanne M. , Karniski Larry P. , Schmidt Darren W. , Kohan Donald E. 
Published: July 2013

Abstract

Background
The benefits of mentoring residents have been studied, but there is no research about mentoring new program directors. Program directors' responsibilities have become increasingly complicated, and they may not be adequately prepared for their role at the time of appointment without the benefit of mentoring that is specific to their new role.

Objective
To assess whether nephrology subspecialty program directors were specifically mentored and whether they felt prepared for the educational and administrative aspects of this role.

Methods
We conducted an electronic needs assessment survey of the nephrology subspecialty program directors through the American Society of Nephrology listserv for program directors.

Results
The survey response rate was 42% (58 of 139). Of the respondents, 58% did not feel adequately prepared when they first became subspecialty program directors, and only 32% reported having formal or informal mentoring for the role. Individuals who had served as associate program directors (34%) were more likely to report mentoring than those who had not (P  =  .02). Eighty percent of respondents reported that mentoring from another nephrology program director would have been beneficial during their first several years.

Conclusions
This appears to be the first study specifically evaluating mentoring experiences relevant to the role of nephrology program director. As a result of this survey, the American Society of Nephrology Training Program Director Executive Committee recognized the need to provide opportunities for mentoring new nephrology program directors and formed a New Training Program Director Training and Mentoring Work Group to recommend initiatives for mentoring and training new program directors. Further investigation is needed to assess whether mentoring benefits subspecialty program directors and whether these findings can be generalized to other specialties and subspecialties.
A Pilot Study Assessing Knowledge of Clinical Signs and Physical Examination Skills in Incoming Medicine Residents
Authors: Ramani Subha , Ring Brandi N. , Lowe Robert , Hunter David 
Published: July 2013

Abstract

Background
Physical exam skills of medical trainees are declining, but most residencies do not offer systematic clinical skills teaching or assessment.

Objective
To assess knowledge of clinical signs and physical exam performance among incoming internal medicine residents.

Method
For this study, 45 incoming residents completed a multiple choice question test to assess knowledge of clinical signs. A random selection of 20 underwent a faculty-observed objective structured clinical examination (OSCE) using patients with abnormal physical findings. Mean percentage scores were computed for the multiple choice question test, overall OSCE, and the 5 individual OSCE systems.

Results
The mean scores were 58.4% (14.6 of 25; SD 11. 5) for the multiple choice question test and 54.7% (31.7 of 58; SD 11.0) for the overall OSCE. Mean OSCE scores by system were cardiovascular 30.0%, pulmonary 69.2%, abdominal 61.6%, neurologic 67.0%, and musculoskeletal 41.7%. Analysis of variance showed a difference in OSCE system scores (P &lt; .001) with cardiovascular and musculoskeletal scores significantly lower than other systems.

Conclusion
Overall, physical exam knowledge and performance of new residents were unsatisfactory. There appears to be a pressing need for additional clinical skills training during medical school and residency training and we are planning a new clinical skills curriculum to address this deficiency.