bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality Education and Safe Systems Training (QuESST): Development and Assessment of a Comprehensive Cross-Disciplinary Resident Quality and Patient Safety Curriculum
Authors: Reznek Martin A. , DiGiovine Bruno , Kromrei Heidi , Levine Diane , Wiese-Rometsch Wilhelmine , Schreiber Michelle 
Published: July 2013

Abstract

Background
Over the past decade, regulatory bodies have heightened their emphasis on health care quality and safety. Education of physicians is a priority in this effort, with the Accreditation Council for Graduate Medical Education requiring that trainees attain competence in practice-based learning and improvement and systems-based practice. To date, several studies about the use of resident education related to quality and safety have been published, but no comprehensive interdisciplinary curricula seem to exist. Effective, formal, comprehensive cross-disciplinary resident training in quality and patient safety appear to be a vital need.

Methods
To address the need for comprehensive resident training in quality and patient safety, we developed and assessed a formal standardized cross-disciplinary curriculum entitled Quality Education and Safe Systems Training (QuESST). The curriculum was offered to first-year residents in a large urban medical center. Preintervention and postintervention assessments and participant perception surveys evaluated the effectiveness and educational value of QuESST.

Results
A total of 138 first-year medical and pharmacy residents participated in the QuESST course. Paired analysis of preintervention and postintervention assessments showed significant improvement in participants' knowledge of quality and patient safety. Participants' perceptions about the value of the curriculum were favorable, as evidenced by a mean response of 1.8 on a scale of 1 (strongly agree) to 5 (strongly disagree) that the course should be taught to subsequent residency classes.

Conclusion
QuESST is an effective comprehensive quality curriculum for residents. Based on these findings, our institution has made QuESST mandatory for all future first-year resident cohorts. Other institutions should explore the value of QuESST or a similar curriculum for enhancing resident competence in quality and patient safety.
Resident Evaluation and Remediation: A Comprehensive Approach
Authors: Wu Jim S. , Siewert Bettina , Boiselle Phillip M. 
Published: July 2013

Abstract

Background
A comprehensive evaluation and remediation program is an essential component of any residency program. The evaluation system should identify problems accurately and early and allow residents with problems to be assigned to a remediation program that effectively deals with them. Elements of a proactive remediation program include a process for outlining deficiencies, providing resources for improvement, communicating clear goals for acceptable performance, and reevaluating performance against these goals.

Intervention
In recognition of the importance of early detection and prompt remediation of the struggling resident, we sought to develop a multifaceted approach to resident evaluation with the aim of early identification and prompt remediation of difficulties. This article describes our comprehensive evaluation program and remediation program, which uses resources within our radiology department and institutional graduate medical education office.

Discussion
An effective evaluation system should identify problems accurately and early, whereas a proactive remediation program should effectively deal with issues once they are identified.
The 4∶1 Schedule: A Novel Template for Internal Medicine Residencies
Authors: Mariotti Jennifer L. , Shalaby Marc , Fitzgibbons John P. 
Published: July 2013

Abstract

Background
It is widely acknowledged that there is need for redesign of internal medicine training. Duty hour restrictions, an increasing focus on patient safety, the possibility of inadequate training in ambulatory care, and a growing shortage of primary care physicians are some factors that fuel this redesign movement.

Intervention
We implemented a 4∶1 scheduling template that alternates traditional 4-week rotations with week-long ambulatory blocks. Annually, this provides 10 blocks of traditional rotations without continuity clinic sessions and 10 weeks of ambulatory experience without inpatient responsibilities. To ensure continuous resident presence in all areas, residents are divided into 5 groups, each staggered by 1 week.

Evaluation
We surveyed residents and faculty before and after the intervention, with questions focused on attitudes toward ambulatory medicine and training. We also conducted focus groups with independent groups of residents and faculty, designed to assess the benefits and drawbacks of the new scheduling template and to identify areas for future improvement.

Results
Overall, the scheduling template minimized the conflicts between inpatient and outpatient training, promoted a stronger emphasis on ambulatory education, allowed for focused practice during traditional rotations, and enhanced perceptions of team development. By creating an immersion experience in ambulatory training, the template allowed up to 180 continuity clinic sessions during 3 years of training and provided improved educational continuity and continuity of patient care.

Conclusion
Separating inpatient and ambulatory education allows for enhanced modeling of the evolving practice of internists and removes some of the conflict inherent in the present system.
The Effect of Blinded Versus Nonblinded Interviews in the Resident Selection Process
Authors: Brustman Lois E. , Williams Fern L. , Carroll Katherine , Lurie Heather , Ganz Eric , Langer Oded 
Published: July 2013

Abstract

Objective
To evaluate whether resident applicants' academic performance biases the assessment of nonacademic qualities.

Methods
In this prospective, descriptive study, 2 blinded (personal statement only) and 1 nonblinded (application) 30-minute interviews were compared for candidates ranking into Top 10, Upper Third, Middle Thirds, Lower Third, and Do Not Rank classes.

Results
A total of 234 candidates were interviewed from 2005 to 2007. The association between blinded interviewers for the categories was 87%, 63%, 68%, 73%, and 90% (P  =  .0000), respectively. Comparing blinded to nonblinded interviewers showed an association of 75% (63%), 71% (86%), 68% (58%), 66% (79%), and 72.7% (82%) (P  =  .0000), respectively. A strong degree of agreement (Cohen κ, 0.75) for the 2 ranking scores resulted in 90% agreement for Top 10 and Upper Third and 85% for Middle Third and Lower Third categories. No correlation was found between United States Medical Licensing Examination scores and final ranking; moderate agreement was found between ranking and deans' letters (Cohen κ, 0.59, P  =  .0000).

Conclusion
Candidate rankings on nonacademic attributes were not affected by interview type.
A Multirater Instrument for the Assessment of Simulated Pediatric Crises
Authors: Calhoun Aaron W , Boone Megan , Miller Karen H , Taulbee Rebecca L , Montgomery Vicki L , Boland Kimberly 
Published: July 2013

Abstract

Background
Few validated instruments exist to measure pediatric code team skills. The goal of this study was to develop an instrument for the assessment of resuscitation competency and self-appraisal using multirater and gap analysis methodologies.

Methods
Multirater assessment with gap analysis is a robust methodology that enables the measurement of self-appraisal as well as competency, offering faculty the ability to provide enhanced feedback. The Team Performance during Simulated Crises Instrument (TPDSCI) was grounded in the Accreditation Council for Graduate Medical Education competencies. The instrument contains 5 competencies, each assessed by a series of descriptive rubrics. It was piloted during a series of simulation-based interdisciplinary pediatric crisis resource management education sessions. Course faculty assessed participants, who also did self-assessments. Internal consistency and interrater reliability were analyzed using Cronbach α and intraclass correlation (ICC) statistics. Gap analysis results were examined descriptively.

Results
Cronbach α for the instrument was between 0.72 and 0.69. The overall ICC was 0.82. ICC values for the medical knowledge, clinical skills, communication skills, and systems-based practice were between 0.87 and 0.72. The ICC for the professionalism domain was 0.22. Further examination of the professionalism competency revealed a positive skew, 43 simulated sessions (98%) had significant gaps for at least one of the competencies, 38 sessions (86%) had gaps indicating self-overappraisal, and 15 sessions (34%) had gaps indicating self-underappraisal.

Conclusions
The TPDSCI possesses good measures of internal consistency and interrater reliability with respect to medical knowledge, clinical skills, communication skills, systems-based practice, and overall competence in the context of simulated interdisciplinary pediatric medical crises. Professionalism remains difficult to assess. These results provide an encouraging first step toward instrument validation. Gap analysis reveals disparities between faculty and self-assessments that indicate inadequate participant self-reflection. Identifying self-overappraisal can facilitate focused interventions.
Resident Training in the Psychiatric Emergency Service: Duty Hours Tell Only Part of the Story
Authors: McIlwrick Joann , Lockyer Jocelyn 
Published: July 2013

Abstract

Background
Psychiatry residents in North America are generally required to work on-call on the psychiatric emergency service (PES) during training. Resident discontent with the long hours, onerous case loads, and lack of on-call teaching has been reported as a barrier to PES training. Given that the PES is a longitudinal and important experience, we sought to develop a better understanding of this service from the resident perspective and identify factors that affect residents as they work and train in this area.

Methods
In this grounded theory qualitative study, we collected data from focus groups with psychiatry residents. We analyzed data according to grounded theory methodology to develop an enhanced understanding of the resident experience on the PES.

Results
Three major themes emerged from data analysis: (1) challenges residents face in the PES are complex and attributable to more than simply long duty hours, (2) the PES offers unique learning opportunities for residents, and (3) resident satisfaction with the PES depends on a good relationship with the team.

Conclusions
This study highlights important topics for any residency programs that require residents to work on a PES team. Although much attention has been paid to addressing challenges inherent to the on-call experience, such as limiting the amount of on-call hours and call frequency, equal attention should be paid to team dynamics. Like prior work on physician contentment and multidisciplinary team functioning, our study found that physicians will tolerate stressful workplace factors, so long as there is a supportive and healthy team dynamic. It is important for program directors to identify problems with team dynamics in the PES in light of their potential impact on residents.
Curriculum Providing Cognitive Knowledge and Problem-Solving Skills for Anesthesia Systems-Based Practice
Authors: Wachtel Ruth E. , Dexter Franklin 
Published: July 2013

Abstract

Background
Residency programs accredited by the ACGME are required to teach core competencies, including systems-based practice (SBP). Projects are important for satisfying this competency, but the level of knowledge and problem-solving skills required presupposes a basic understanding of the field. The responsibilities of anesthesiologists include the coordination of patient flow in the surgical suite. Familiarity with this topic is crucial for many improvement projects.

Intervention
A course in operations research for surgical services was originally developed for hospital administration students. It satisfies 2 of the Institute of Medicine's core competencies for health professionals: evidence-based practice and work in interdisciplinary teams. The course lasts 3.5 days (eg, 2 weekends) and consists of 45 cognitive objectives taught using 7 published articles, 10 lectures, and 156 computer-assisted problem-solving exercises based on 17 case studies. We tested the hypothesis that the cognitive objectives of the curriculum provide the knowledge and problem-solving skills necessary to perform projects that satisfy the SBP competency. Standardized terminology was used to define each component of the SBP competency for the minimum level of knowledge needed. The 8 components of the competency were examined independently.

Findings
Most cognitive objectives contributed to at least 4 of the 8 core components of the SBP competency. Each component of SBP is addressed at the minimum requirement level of exemplify by at least 6 objectives. There is at least 1 cognitive objective at the level of summarize for each SBP component.

Conclusions
A curriculum in operating room management can provide the knowledge and problem-solving skills anesthesiologists need for participation in projects that satisfy the SBP competency.
Pediatric Intensive Care Simulation Course: A New Paradigm in Teaching
Authors: Tofil Nancy M , Benner Kim W , Zinkan Lynn , Alten Jeffrey , Varisco Brian M , White Marjorie Lee 
Published: July 2013

AbstractObjectiveTrue pediatric emergencies are rare. Because resident work hours are restricted and national attention turns toward patient safety, teaching methods to improve physician performance and patient care are vital. We hypothesize that a critical-care simulation course will improve resident confidence and performance in critical-care situations.InterventionsWe developed a monthly pediatric intensive care unit simulation course for second-year pediatric residents that consisted of weekly 1-hour sessions during both of the residents' month-long pediatric intensive care unit rotations. All scenarios used high-fidelity pediatric simulators and immediate videotape-assisted debriefing sessions. In addition, simulated intraosseous line insertion and endotracheal intubations were also performed.ResultsAll residents improved their comfort level and confidence in performing individual key resuscitation tasks. The largest improvements were seen with their perceived ability to intubate children and place intraosseous lines. Both of these skills improved from baseline and compared to third-year-resident controls who had pediatric intensive care unit rotations but no simulations (P = .05 and P = .07, respectively). Videotape reviews showed only 54% ± 12% of skills from a scenario checklist performed correctly.ConclusionsOur simulation-based pediatric intensive care unit training course improves second-year pediatric residents' comfort level but not performance during codes, as well as their perceived intubation and intraosseous ability. Videotape reviews show discordance between objective performance and self-assessment. Further work is necessary to elucidate the reasons for this difference as well as the appropriate role for simulation in the new graduate medical education climate, and to create new teaching modalities to improve resident performance.
Professional Bankruptcy for the Academic Physician
Authors: Thornburg Loralei L. , Glantz J. Christopher , Caprio Thomas V. , Gillespie Suzanne M. 
Published: July 2013

Abstract
In modern academic medicine, the amount of academic time is decreasing as the workload and commitments are increasing. As physicians take on so many professional obligations that there is no way to meet all of the demands of the ever-expanding responsibilities, the question becomes: Should academic physicians ever consider filing for their own “professional bankruptcy”? Presented here are 10 steps to successful academic bankruptcy for the overextended junior faculty. Although somewhat fanciful, this method allows faculty to take an honest and critical assessment of their personal and professional goals and to align their career with these goals. With a critical eye to the future, this alignment will allow faculty to decrease their workload while maintaining productivity.
Teaching Risk Management: Addressing ACGME Core Competencies
Authors: Nissen Kiki , Angus Steven V. , Miller Wendy , Silverman Adam R. 
Published: July 2013

Abstract

Background
Risk management is an important aspect of education for all residents. Unfortunately, few curricula currently exist to fulfill this educational need.

Objective
We developed a curriculum that teaches residents basic principles of risk management with the goals of (1) educating residents about the medical-legal environment in which they operate, (2) helping residents identify common malpractice exposures, and (3) teaching practical risk management/patient safety interventions that can be implemented in their practice that could reduce malpractice exposure and improve patient safety.

Methods
The curriculum was developed by Medical Risk Management, LLC, a Connecticut-based risk management firm, in conjunction with academic leadership at the University of Connecticut. The program uses 3 learning modalities: live lectures, web-based video modules, and e-mailed learning publications. Gains in resident knowledge through participation in the curriculum were measured using pretests and posttests. Learner satisfaction with the curriculum was measured through web-based surveys.

Results
We found a significant improvement in knowledge in residents who took the pretest and posttest (P &lt; .001). Of the survey respondents, 97% said the content was relevant to their specialty practice and 95% responded that these sessions should be held annually. Most respondents indicated they would change their practice as a result of what they learned from the live lectures.

Conclusion
This risk management curriculum has been successful in providing our residents with learning activities in risk management, improving their knowledge of risk management principles, and changing their attitudes and behaviors. These improvements may lead to fewer malpractice claims against them and the hospitals they train in.
Resident Career Planning Needs in Internal Medicine: A Qualitative Assessment
Authors: Garcia Rina L. , Windish Donna M. , Rosenbaum Julie R. 
Published: July 2013

Abstract

Background
Few residency programs have centralized resources for career planning. As a consequence, little is known about residents' informational needs regarding career planning.

Objective
To examine career preparation stressors, practical needs, and information that residents wished they were privy to when applying.

Methods
In 2007 and 2008, we surveyed 163 recent graduates or graduating residents from 10 Yale-based and Yale-affiliated hospitals' internal medicine programs regarding their experiences with applying for positions after residency. We included questions about demographics, mentorship, stress of finding a job or fellowship, and open-ended questions to assess barriers and frustrations. Qualitative data were coded independently and a classification scheme was negotiated by consensus.

Results
A total of 89 residents or recent graduates responded, and 75% of them found career planning during residency training at least somewhat stressful. Themes regarding the application process included (1) knowledge about the process, (2) knowledge about career paths and opportunities, (3) time factors, (4) importance of adequate personal guidance and mentorship, and (5) self-knowledge regarding priorities and the desired outcome. Residents identified the following advice as most important: (1) start the process as early as possible and with a clear knowledge of the process timeline, (2) be clear about personal goals and priorities, and (3) be well-informed about a prospective employer and what that employer is looking for. Most residents felt career planning should be structured into the curriculum and should occur in the first year or throughout residency.

Conclusions
This study highlights residents' desire for structured dissemination of information and counseling with regard to career planning during residency. Our data suggest that exposure to such resources may be beneficial as early as the first year of training.
Training Intensivists and Clinician-Scientists for the 21st Century: The Oregon Scholars Program
Authors: Juve Amy Miller , Kirsch Jeffrey R. , Swide Christopher 
Published: July 2013

Abstract

Background
Innovation is important for the development and advancement of any medical specialty. Leaders in anesthesiology have emphasized the need for more training in critical care and additional research to advance our specialty.

Intervention
To help address this need, Oregon Health & Science University (OHSU) developed an innovative training program that combines a critical care medicine (CCM) or research fellowship with traditional clinical anesthesia training. This article outlines the program structure, challenges, and successes of this innovative approach to training anesthesiology clinicians and scientists.

Findings
Since the program began in 2006, we have filled all available positions and currently have 9 scholars in the anesthesiology/CCM track and 3 in the anesthesiology/research track at the postgraduate year-2 to postgraduate year-5 levels. Our first class of scholars graduated in the summer of 2010. The Oregon Scholars Program (OSP) scholars and faculty have confronted challenges, including the transition from resident in the operating rooms to fellow in the critical care units. In 2007, our residents acknowledged the OSP/CCM scholars' expertise in CCM and have looked to them as teachers and advocates for their education during their CCM rotations. In July 2007, OHSU received a National Institutes of Health T32 training grant to support the research component of the OSP. OSP scholars' research productivity has resulted in 11 publications, 3 abstracts, 3 presentations, 3 research grants, and 1 resident research award. Several other anesthesiology programs have recently instituted similar programs to address the need for anesthesiologists trained as intensivists and clinician-scientists.