bluuebunny/crossref_metadata_2025_split huggingface dataset:
Resident Scores on a Patient Satisfaction Survey: Evidence for Maintenance of Communication Skills Throughout Residency
Authors: Stewart Emily A. , Marzio Dina Halegoua-De , Guggenheim Douglas E. , Gotto Joanne , Veloski J. Jon , Kane Gregory C. 
Published: July 2013

Abstract

Objective
To examine whether resident communication skills evaluated through patient satisfaction surveys demonstrate evidence of decline through the 3 years of internal medicine residency.

Methods
Data for this study were collected retrospectively from a database of patient satisfaction surveys completed for internal medicine residents at different levels of training. Patient satisfaction was measured with the Aggregated EVGFP (excellent, very good, good, fair, or poor) questionnaire recommended by the American Board of Internal Medicine.

Results
Over a span of 5 years (2005–2009), a total of 768 patient rating forms were completed for 67 residents during their 3 years of residency training. In postgraduate year (PGY)–1, the residents had a mean satisfaction rating of 4.33 ± 0.48 compared to a mean rating of 4.37 ± 0.45 in their PGY-3 year. Analysis of variance indicated no significant difference by PGY level.

Conclusion
Our findings demonstrate that resident communication skills and patient satisfaction do not decline during the 3 years of residency. This is contrary to our hypothesis that patient satisfaction would worsen as residents progressed through training.
Incorporating Evidence into Clinical Teaching: Enhanced Geriatrics Specialty Case-Based Residency Presentations
Authors: Powers James S. , Cahall Molly , Epelbaum Marcia , Habermann Ralf , Rosenstiel Donna , Giuse Nunzia 
Published: July 2013

Abstract

Introduction
Case-based presentations are widely used in medical education and are a preferred education modality to teach about the care of geriatric patients across a range of medical specialties.

Methods
We incorporated evidence-based materials from topical literature syntheses into case-based presentations on the care of geriatric patients for use by specialty residents. These enhanced case-based presentations were used to augment learning and to facilitate detection of additional educational needs for future resident training sessions.

Results
Forty case-based presentations were presented to 11 specialty programs during a 4-year period. The program was popular, and program directors and residents requested additional presentations. Geriatric evidence-based summaries were viewed online 375 times during the course of the project. Geriatric clinical consults increased from an average of 10 consults a year to 141 from 64 different providers during the first year.

Discussion
Case-based presentation, enhanced with evidence-based summaries of research literature generated by information specialists, is a feasible and effective approach to teaching clinical content. These presentations can be used to target geriatrics educational competencies for resident trainees in nongeriatric specialties.
Internal Medicine Residents' Time Study: Paperwork Versus Patient Care
Authors: Alromaihi Dalal , Godfrey Amanda , Dimoski Tina , Gunnels Paul , Scher Eric , Baker-Genaw Kimberly 
Published: July 2013

Abstract

Background
Multiple factors affect residency education, including duty-hour restrictions and documentation requirements for regulatory compliance. We designed a work sampling study to determine the proportion of time residents spend in structured education, direct patient care, indirect patient care that must be completed by a physician, indirect patient care that may be delegated to other health care workers, and personal activities while on an inpatient general practice unit.

Methods
The 3-month study in 2009 involved 14 categorical internal medicine residents who volunteered to use personal digital assistants to self-report their location and primary tasks while on an inpatient general practice unit.

Results
Residents reported spending most of their time at workstations (43%) and less time in patient rooms (20%). By task, residents spent 39% of time on indirect patient care that must be completed by a physician, 31% on structured education, 17% on direct patient care, 9% on indirect patient care that may be delegated to other health care workers, and 4% on personal activities. From these data we estimated that residents spend 34 minutes per patient per day completing indirect patient care tasks compared with 15 minutes per patient per day in direct patient care.

Conclusions
This single-institution time study objectively quantified a current state of how and where internal medicine residents spend their time while on a general practice unit, showing that residents overall spend less time on direct patient care compared with other activities.
Preparing for Oral Scientific and Clinical Vignette Presentations
Authors: Snyder Erin D. , Salanitro Amanda H. , Estrada Carlos , Centor Robert M. , Castiglioni Analia 
Published: July 2013

Abstract

Background
Little is known about how faculty, residents, and fellows practice for oral presentations at academic meetings. We sought to categorize presenters' practice styles and the impact of feedback.

Methods
We surveyed oral presenters at 5 annual academic general internal medicine meetings between 2008 and 2010, using a cross-sectional design. Main measures were frequency and settings of practice, most helpful practice setting, changes made in response to feedback, impact of feedback, and perceived quality of presentation.

Results
The response rate was 63% (333/525 responders). Respondents represented 59 academic medical centers. Presenters reported practicing in a mean ± SD of 2.3 (±1.3) of 5 different settings. Of the 46% of presenters (152/333) who practiced in front of a group of more experienced colleagues, 80% of presenters (122/152) reported it was the most helpful setting. Eighty-one percent of presenters (268/333) practiced alone, and 25% of presenters (82/333) reported practicing alone was the most helpful setting. The mean numbers of change types reported by faculty were fewer than those reported by residents and fellows (mean 2.3 ± 1.8, and 3.1 ± 2.0, respectively; P &lt; .001). Practicing alone was not associated with changes in content (P  =  .30), visual aids (P  =  .12), or delivery style (P  =  .53).

Conclusions
Practicing in front of a group of experienced colleagues was the most helpful setting in which to prepare for an oral academic meeting presentation, but it was not universally utilized. Feedback given at these sessions was more likely to result in changes made to the presentation; however, broader implementation of such sessions may require institutional support.
Comprehensive Training Curricula for Minimally Invasive Surgery
Authors: Palter Vanessa N 
Published: July 2013

AbstractBackgroundThe unique skill set required for minimally invasive surgery has in part contributed to a certain portion of surgical residency training transitioning from the operating room to the surgical skills laboratory. Simulation lends itself well as a method to shorten the learning curve for minimally invasive surgery by allowing trainees to practice the unique motor skills required for this type of surgery in a safe, structured environment. Although a significant amount of important work has been done to validate simulators as viable systems for teaching technical skills outside the operating room, the next step is to integrate simulation training into a comprehensive curriculum.ObjectivesThis narrative review aims to synthesize the evidence and educational theories underlining curricula development for technical skills both in a broad context and specifically as it pertains to minimally invasive surgery.FindingsThe review highlights the critical aspects of simulation training, such as the effective provision of feedback, deliberate practice, training to proficiency, the opportunity to practice at varying levels of difficulty, and the inclusion of both cognitive teaching and hands-on training. In addition, frameworks for integrating simulation training into a comprehensive curriculum are described. Finally, existing curricula on both laparoscopic box trainers and virtual reality simulators are critically evaluated.
Redesign of an Internal Medicine Ward Rotation: Operational Challenges and Outcomes
Authors: Pierce J. Rush , Chang Betty , Rogers Kendall M. , Jernigan Jennifer R. , Fotieo Dana R. , Kang Huining , Leverence Robert R. 
Published: July 2013

Abstract

Introduction
In anticipation of the 2011 ACGME duty hour requirements, we redesigned our internal medicine resident ward experience. Our previous ward structure included a maximum 30-hour duty period for postgraduate year-1 (PGY-1) residents. In the redesigned ward structure, PGY-1 residents had a maximum 18-hour duty period.

Methods
We evaluated resident conference attendance and duty hour violations before and after implementation of our new ward redesign. We administered a satisfaction survey to residents and faculty 6 months after implementation of the new ward redesign.

Results
Before implementation of the ward redesign, 30-hour continuous and 80-h/wk duty violations were each 2/year, and violations of the 10-hour rest between duty periods were 10/year for 74 residents. After implementation of the ward redesign, there were no 30-hour continuous or 80-h/wk duty violations, but violations of the 10-hour rest between duty periods more than doubled (26/year for 75 residents). Duty hours were reported by different mechanisms for the 2 periods. Conference attendance improved. Resident versus faculty satisfaction scores were similar. Both groups judged overall professional satisfaction as slightly worse after implementation.

Conclusion
Our ward rotation redesign eliminated 30-hour continuous and 80-h/wk duty violations as well as improved conference attendance. These benefits occurred at the cost of more faculty hires, decreased resident elective time, and slightly worse postimplementation satisfaction scores.
Prospective Comparison of Live Evaluation and Video Review in the Evaluation of Operator Performance in a Pediatric Emergency Airway Simulation
Authors: House Joseph B. , Dooley-Hash Suzanne , Kowalenko Terry , Sikavitsas Athina , Seeyave Desiree M. , Younger John G. , Hamstra Stanley J. , Nypaver Michele M. 
Published: July 2013

Abstract

Introduction
Real-time assessment of operator performance during procedural simulation is a common practice that requires undivided attention by 1 or more reviewers, potentially over many repetitions of the same case.

Objective
To determine whether reviewers display better interrater agreement of procedural competency when observing recorded, rather than live, performance; and to develop an assessment tool for pediatric rapid sequence intubation (pRSI).

Methods
A framework of a previously established Objective Structured Assessment of Technical Skills (OSATS) tool was modified for pRSI. Emergency medicine residents (postgraduate year 1–4) were prospectively enrolled in a pRSI simulation scenario and evaluated by 2 live raters using the modified tool. Sessions were videotaped and reviewed by the same raters at least 4 months later. Raters were blinded to their initial rating. Interrater agreement was determined by using the Krippendorff generalized concordance method.

Results
Overall interrater agreement for live review was 0.75 (95% confidence interval [CI], 0.72–0.78) and for video was 0.79 (95% CI, 0.73–0.82). Live review was significantly superior to video review in only 1 of the OSATS domains (Preparation) and was equivalent in the other domains. Intrarater agreement between the live and video evaluation was very good, greater than 0.75 for all raters, with a mean of 0.81 (95% CI, 0.76–0.85).

Conclusion
The modified OSATS assessment tool demonstrated some evidence of validity in discriminating among levels of resident experience and high interreviewer reliability. With this tool, intrareviewer reliability was high between live and 4-months' delayed video review of the simulated procedure, which supports feasibility of delayed video review in resident assessment.
A Randomized Controlled Trial of the Impact of a Teaching Procedure Service on the Training of Internal Medicine Residents
Authors: Mourad Michelle , Ranji Sumant , Sliwka Diane 
Published: July 2013

Abstract

Introduction
Academic medical centers must provide safe inpatient procedures while balancing resident autonomy and education. We performed a randomized, controlled trial to evaluate the effect of a 2-week hospitalist procedure service (HPS) rotation on interns' self-perceived procedure ability, knowledge, and autonomy versus the standard curriculum.

Methods
We randomly selected 16 of 57 internal medicine interns (28%) to participate in the intervention group rotation, with 29 interns in the control group. All interns were surveyed before the start of residency and at the end of the postgraduate year-1 (PGY-1) and PGY-2 years to evaluate self-reported knowledge and ability to (1) safely perform procedures, (2) supervise procedures, and (3) use bedside ultrasound.

Results
Ninety-four percent of HPS interns (15/16) and 71% of control interns (29/41) completed all surveys. Baseline knowledge and experience did not differ significantly between the groups. The intervention group performed significantly more paracentesis (9 versus 4; P &lt; .001), thoracentesis (6 versus 2; P &lt; .001), and lumbar puncture (4 versus 3; P &lt; .001) procedures than did the control group. After their first year, residents who completed the HPS rotation rated their ability to safely perform and supervise all of the assessed procedures as higher (P &lt; .05 for all procedures) and were more likely to rate self-perceived knowledge as very good or excellent in all surveyed aspects of procedure performance (P &lt; .05).

Discussion
A 2-week hospitalist-supervised procedure service rotation substantially improved residents' experience, confidence, and knowledge in performing bedside procedures early in their training, with this effect sustained through the PGY-2 year. Standardized procedure service rotations are a viable solution for programs seeking to improve their procedure-based education.
Determining Need for Remediation Through Postrotation Evaluations
Authors: Guerrasio Jeannette , Cumbler Ethan , Trosterman Adam , Wald Heidi , Brandenburg Suzanne , Aagaard Eva 
Published: July 2013

Abstract

Introduction
Postrotation evaluations are frequently used by residency program directors for early detection of residents with academic difficulties; however, the accuracy of these evaluations in assessing resident performance has been questioned.

Methods
This retrospective case-control study examines the ability of postrotation evaluation characteristics to predict the need for remediation. We compared the evaluations of 17 residents who were placed on academic warning or probation, from 2000 to 2007, with those for a group of peers matched on sex, postgraduate year (PGY), and entering class.

Results
The presence of an outlier evaluation, the number of words written in the comments section, and the percentage of evaluations with negative or ambiguous comments were all associated with the need for remediation (P  =  .01, P  =  .001, P  =  .002, P  =  &lt; .001, respectively). In contrast, United States Medical Licensing Examination step 1 and step 2 scores, total number of evaluations received, and percentage of positive comments on the evaluations were not associated with the need for remediation (P  =  .06, P  =  .87, P  =  .55, respectively).

Discussion
Despite ambiguous evaluation comments, the length and percentage of ambiguous or negative comments did indicate future need for remediation.

Conclusions
Our study demonstrates that postrotation evaluation characteristics can be used to identify residents as risk. However, larger prospective studies, encompassing multiple institutions, are needed to validate various evaluation methods in measuring resident performance and to accurately predict the need for remediation.
A Novel Comprehensive In-Training Examination Course Can Improve Residency-Wide Scores
Authors: Sharma Rahul , Sperling Jeremy D. , Greenwald Peter W. , Carter Wallace A. 
Published: July 2013

Abstract

Introduction
The annual American Board of Emergency Medicine (ABEM) in-training examination is a tool to assess resident progress and knowledge. We implemented a course at the New York-Presbyterian Emergency Medicine Residency Program to improve ABEM scores and evaluate its effect. Previously, the examination was not emphasized and resident performance was lower than expected.

Methods
As an adjunct to required weekly residency conferences, an intensive 14-week in-training examination preparation program was developed that included lectures, pre-tests, high-yield study sheets, and a remediation program. We compared each residents in-training examination score to the postgraduate year-matched national mean. Scores before and after course implementation were evaluated by repeat measures regression modeling. Residency performance was evaluated by comparing residency average to the national average each year and by tracking ABEM national written examination pass rates.

Results
Following the course's introduction, odds of a resident scoring higher than the national average increased by 3.9 (95% CI 1.9-7.3) and percentage of residents exceeding the national average increased by 37% (95% CI 23%-52%). In the time since the course was started the overall residency mean score has outperformed the national average and the first-time ABEM written examination board pass rate has been 100%.

Conclusion
A multifaceted residency-wide examination curriculum focused around an intensive 14-week course was associated with marked improvement on the in-training examination.
Simulation-Based Education with Mastery Learning Improves Paracentesis Skills
Authors: Barsuk Jeffrey H. , Cohen Elaine R. , Vozenilek John A. , O'Connor Lanty M. , McGaghie William C. , Wayne Diane B. 
Published: July 2013

Abstract

Background
Paracentesis is a commonly performed bedside procedure that has the potential for serious complications. Therefore, simulation-based education for paracentesis is valuable for clinicians.

Objective
To assess internal medicine residents' procedural skills before and after simulation-based mastery learning on a paracentesis simulator.

Methods
A team with expertise in simulation and procedural skills developed and created a high fidelity, ultrasound-compatible paracentesis simulator. Fifty-eight first-year internal medicine residents completed a mastery learning-based intervention using the paracentesis simulator. Residents underwent baseline skill assessment (pretest) using a 25-item checklist. Residents completed a posttest after a 3-hour education session featuring a demonstration of the procedure, deliberate practice, ultrasound training, and feedback. All residents were expected to meet or exceed a minimum passing score (MPS) at posttest, the key feature of mastery learning. We compared pretest and posttest checklist scores to evaluate the effect of the educational intervention. Residents rated the training sessions.

Results
Residents' paracentesis skills improved from an average pretest score of 33.0% (SD  =  15.2%) to 92.7% (SD  =  5.4%) at posttest (P &lt; .001). After the training intervention, all residents met or exceeded the MPS. The training sessions and realism of the simulation were rated highly by learners.

Conclusion
This study demonstrates the ability of a paracentesis simulator to significantly improve procedural competence.
Motivational Interviewing in Health Care: Results of a Brief Training in Endocrinology
Authors: Bean Melanie K. , Biskobing Diane , Francis Gary L. , Wickham Edmond 
Published: July 2013

Abstract

Background
Despite the importance of lifestyle change in disease management and the growing evidence supporting motivational interviewing (MI) as an effective counseling method to promote behavioral change, to date there are few published reports about MI training in graduate medical education.

Objective
The study aimed to pilot the feasibility and effectiveness of a brief MI training intervention for endocrinology fellows and other providers.

Methods
We used a pretest/posttest design to evaluate a brief MI training for 5 endocrinology fellows and 9 other providers. All participants completed subjective assessments of perceived confidence and beliefs about behavioral counseling at pretest and posttest. Objective assessment of MI was conducted using fellows' audiotaped patient encounters, which were coded using a validated tool for adherence to MI before and after the training. Paired t tests examined changes in objective and subjective assessments.

Results
The training intervention was well received and feasible in the endocrinology setting. At posttest, participants reported increased endorsement of the MI spirit and improved confidence in MI skills. Objective assessment revealed relative improvements in MI skills across several domains. However, most domains, as assessed by a validated tool, did not reach competency level after the training intervention.

Conclusions
Although more intensive training may be needed to develop MI competence, the results of our pilot study suggest that brief, targeted MI training has short-term efficacy and is well received by endocrinology fellows and other providers.
Resident Perceptions of Service Versus Clinical Education
Authors: Galvin Shelley L. , Buys Elizabeth 
Published: July 2013

Abstract

Background
The Accreditation Council for Graduate Medical Education states that education needs to have priority over service. There is a potential for residents to have a negative perception of activities termed service.

Objective
To understand how residents of one obstetrics and gynecology program conceptualize service and clinical education in their daily training experiences.

Methods
We conducted a qualitative survey using semistructured interviews with 9 residents in obstetrics and gynecology. Verbatim transcripts underwent phenomenologic analysis for themes and statements exemplifying the essence and nuances of residents' experiences.

Results
The conceptualization of service and clinical education encompassed 6 categories, with some overlap between terms. The category education encompassed (1) tasks and situations with some educational value termed indirect patient care; (2) tasks and situations with high educational values subdivided into direct patient care and teacher-learner interactions; and (3) traditional educational activities, including reflection. Service denoted: (1) tasks and situations with little to no educational value subdivided into indirect and direct patient care categories; (2) tasks and situations with some educational value described as direct patient care; and (3) community service to patients and communities.

Conclusions
Definitions and the relative educational value of service and clinical education experiences overlapped considerably, but they varied by systematic, environmental, and personal factors. Service was used interchangeably to connote negative experiences that interfered with educational goals and positive experiences at the core of the profession's higher calling, the raison d'être of many physicians. The community needs to agree on the definitions of these terms and clarify the meaning of an appropriate balance.