bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fatigue Optimization Scheduling in Graduate Medical Education: Reducing Fatigue and Improving Patient Safety
Authors: McCormick Frank , Kadzielski John , Evans Brady T. , Landrigan Christopher P. , Herndon James , Rubash Harry 
Published: July 2013

Abstract

Background
Medical error is a major cause of preventable morbidity and mortality. Resident fatigue is likely to be a significant contributor.

Objectives
We calculated and compared predicted fatigue impairment in surgical residents on varying schedules by using the validated Sleep, Activity, Fatigue, and Task Effectiveness model and Fatigue Avoidance Scheduling Tool; we identified specific times of day and rotations during which residents were most affected, instituted countermeasures, and measured the predicted response.

Methods
We compared 4 scheduling patterns: day shift, trauma shift, night shift, and prework hour restriction Q3 call (or every-third-night call). The dependent variables were mean daily effectiveness while at work and the percentage of time residents worked with critical fatigue impairment (defined as an effectiveness score of less than 70 correlated with an increased risk for error and a blood alcohol content of 0.08). Fatigue countermeasures (ie, a 30-minute nap, eliminating 24-hour shifts) were applied to rotations with significant impairment to determine impairment plasticity.

Results
Calculated mean effectiveness scores and percentage of time spent impaired at work were as follows: day shift, 90.3, 0%; trauma shift, 82.0, 7.5%; prework hour restriction Q3 call shift, 80.7, 23%; and night shift, 68.0, 50% (P &lt; .001). Fatigue optimization countermeasures for night shift rotation improved mean daily effectiveness to 87.1 with only 1.9% of time working while impaired (P &lt; .001).

Conclusions
There is a significant potential for fatigue impairment in residents, with work schedule a significant factor. Once targeted, fatigue impairment may be minimized with specific countermeasures. Fatigue optimization tools provide data for targeted scheduling interventions, which reduce fatigue and may mitigate medical error.
Recent Family Medicine Residency Graduates' Perceptions of Resident Duty Hour Restrictions
Authors: Peterson Lars E. , Diaz Vanessa , Dickerson Lori M. , Player Marty S. , Carek Peter J. 
Published: July 2013

Abstract

Background
Resident duty hour limits, new requirements for supervision, and an enhanced focus on patient safety have shown mixed effects on resident quality of life, patient safety, and resident competency. Few studies have assessed how recent graduates feel these changes have affected their education.

Objective
We assessed recent graduates' perceptions about the effects of duty hour and supervision requirements on their education.

Methods
We conducted a cross-sectional survey of graduates from South Carolina Area Health Education Consortium-affiliated family medicine residency programs from 2005 to 2009 by using logistic regression to determine associations between participant characteristics and survey responses.

Results
Graduates (N  =  136) completed the survey with a 51.3% response rate. Nearly all (96%) reported that residency prepared them for their current work hours; 97% reported they felt adequately supervised; 81% worked fewer hours in practice than in residency; 20% believed the limits had restricted their clinical experience; and 3% felt duty hour limits were more important than supervision. Graduates who practiced in a mid-sized communities were more likely to report duty hour limits restricted their clinical experience than individuals practicing in communities of &lt;10 000 (OR  =  6.30; 95% CI, 1.38–28.72).

Conclusions
Most graduates who responded to the survey felt supervision was equally or more important than limits on resident duty hours. However, 20% of respondents felt that the duty hour standards limited their education. The duty hour and supervision requirements challenge educators to ensure quality education.
Nature and Impact of Interruptions on Clinical Workflow of Medical Residents in the Inpatient Setting
Authors: Ly Theresa , Korb-Wells Cameron S. , Sumpton Daniel , Russo Robert R. , Barnsley Les 
Published: July 2013

Abstract

Background
Medical officers (trainees) in their first to third postgraduate years (PGY-1–3s) work in complex, busy environments, performing tasks that require concentration and application of learned skills. There are frequently competing demands, and being paged is among the most common.

Objective
We quantified and described the effect of interruptions that paging created on the clinical workflow of PGY-1–3s during ward duties.

Methods
This prospective study was conducted at 2 teaching hospitals in Sydney, Australia. Medical students were recruited as observers to log interruptions of PGY-1–3s' workflow arising from pages from other members of the hospital team.

Results
Forty-two pairs consisting of a PGY-1–3 trainee and an observer were recruited, with 24 proceeding to data collection. Nursing was the most frequent source of pages (47%); other medical staff accounted for 16% of pages, allied health for 12%, and others for 24% (with pharmacy the most common). Pages commonly involved direct patient care (46%), followed by medication issues (21%). Tasks interrupted by pages encompassed direct patient care (37%), indirect patient care (15%), and documentation (12%). Only 27% of pages were assessed as appropriate and urgent, while 58% were considered appropriate but not urgent, and 16% were not appropriate. Only 38% of pages were judged to be clinically more important than the task they interrupted.

Conclusions
Pages frequently interrupted direct patient care activities for PGY-1–3 trainees, and a significant proportion of pages were identified as either not requiring immediate attention or not appropriate, resulting in potentially avoidable interruptions to clinical workflow. Alternate means of alerting trainees to nonurgent tasks may reduce interruptions and facilitate patient care.
A Narrative Review of Surgical Resident Duty Hour Limits: Where Do We Go From Here?
Authors: Fabricant Peter D. , Dy Christopher J. , Dare David M. , Bostrom Mathias P. 
Published: July 2013

Abstract

Background
Resident duty hour limits have been a point of debate among educators, administrators, and policymakers alike since the Libby Zion case in 1984. Advocates for duty hour limits in the surgical subspecialties cite improvements in patient safety, whereas opponents claim that limiting resident duty hours jeopardizes resident education and preparedness for independent surgical practice.

Methods
Using orthopaedic surgery as an example, we describe the historical context of the implementation of the duty hour standards, provide a review of the literature presenting data that both supports and refutes continued restrictions, and outline suggestions for policy going forward that prioritize patient safety while maintaining an enhanced environment for resident education.

Results
Although patient safety markers have improved in some studies since the implementation of duty hour limits, it is unclear whether this is due to changes in residency training or external factors. The literature is mixed regarding academic performance and trainee readiness during and after residency.

Conclusion
Although excessive duty hours and resident fatigue may have historically contributed to errors in the delivery of patient care, those are certainly not the only concerns. An overall “culture of safety,” which includes pinpointing systematic improvements, identifying potential sources of error, raising performance standards and safety expectations, and implementing multiple layers of protection against medical errors, can continue to augment safety barriers and improve patient care. This can be achieved within a more flexible educational environment that protects resident education and ensures optimal training for the next generation of physicians and surgeons.
Relationship Between Performance on Child and Adolescent Psychiatry In-Training and Certification Examinations
Authors: Juul Dorthea , Sexson Sandra B. , Brooks Beth Ann , Beresin Eugene V. , Bechtold Donald W. , Lang Joan A. , Faulkner Larry R. , Tanguay Peter , Dingle Arden D. 
Published: July 2013

Abstract

Background
Studies across a range of specialties have consistently yielded positive associations between performance on in-training examinations and board certification examinations, supporting the use of the in-training examination as a valuable formative feedback tool for residents and residency programs. That association to date, however, has not been tested in child and adolescent psychiatry residents.

Objective
This is the first study to explore the relationship between performance on the American College of Psychiatrists' Child Psychiatry Resident In-Training Examination (CHILD PRITE) and subsequent performance on the American Board of Psychiatry and Neurology's (ABPN) subspecialty multiple-choice examination (Part I) in child and adolescent psychiatry (CAP).

Methods
Pearson correlation coefficients were used to examine the relationship between performance on the CHILD PRITE and the CAP Part I examination for 342 fellows.

Results
Second-year CAP fellows performed significantly better on the CHILD PRITE than did the first-year fellows. The correlation between the CHILD PRITE total score and the CAP Part I examination total score was .41 (P  =  .01) for first-year CAP fellows; it was .52 (P  =  .01) for second-year CAP fellows.

Conclusions
The significant correlations between scores on the 2 tests show they assess the same achievement domain. This supports the use of the CHILD PRITE as a valid measure of medical knowledge and formative feedback tool in child and adolescent psychiatry.
Training at a Faith-Based Institution Matters for Obstetrics and Gynecology Residents: Results From a Regional Survey
Authors: Guiahi Maryam , Westhoff Carolyn L. , Summers Sondra , Kenton Kimberly 
Published: July 2013

Abstract

Background
Prior data suggest that opportunities in family planning training may be limited during obstetrics and gynecology (Ob-Gyn) residency training, particularly at faith-based institutions with moral and ethical constraints, although this aspect of the Ob-Gyn curriculum has not been formally studied to date.

Objectives
We compared Ob-Gyn residents' self-rated competency and intentions to provide family planning procedures at faith-based versus those of residents at non-faith-based programs.

Methods
We surveyed residents at all 20 Ob-Gyn programs in Illinois, Indiana, Iowa, and Wisconsin from 2008 to 2009. Residents were queried about current skills and future plans to perform family planning procedures. We examined associations based on program and residents' personal characteristics and performed multivariable logistic regression analysis.

Results
A total of 232 of 340 residents (68%) from 17 programs (85%) returned surveys. Seven programs were faith-based. Residents from non-faith-based programs were more likely to be completely satisfied with family planning training (odds ratio [OR]  =  3.4, 95% confidence limit [CI], 1.9–6.2) and to report they “understand and can perform on own” most procedures. Most residents, regardless of program type, planned to provide all surveyed family planning services.

Conclusions
Despite similar intentions to provide family planning procedures after graduation, residents at faith-based training programs were less satisfied with their family planning training and rate their ability to perform family planning services lower than residents at non-faith-based training programs.
Brief Educational Intervention Improves Content of Intern Handovers
Authors: Shaughnessy Erin E. , Ginsbach Kimberly , Groeschl Nicole , Bragg Dawn , Weisgerber Michael 
Published: July 2013

Abstract

Background
The Accreditation Council for Graduate Medical Education requires residency programs to ensure safe patient handovers and to document resident competency in handover communication, yet there are few evidence-based curricula teaching resident handover skills.

Objective
We assessed the immediate and sustained impact of a brief educational intervention on pediatrics intern handover skills.

Methods
Interns at a freestanding children's hospital participated in an intervention that included a 1-hour educational workshop on components of high-quality handovers, as well as implementation of a standardized handover format. The format, SAFETIPS, includes patient information, current diagnosis and assessment, patient acuity, a focused plan, a baseline exam, a to-do list, anticipatory guidance, and potential pointers and pitfalls. Important communication behaviors, such as paraphrasing key information, were addressed. Quality of intern handovers was evaluated using a simulated encounter 2 weeks before, 2 weeks after, and 7 months after the workshop. Two trained, blinded, independent observers scored the videotaped encounters.

Results
All 27 interns rotating at the Children's Hospital consented to participate in the study, and 20 attended the workshop. We included all participant data in the analysis, regardless of workshop attendance. Following the intervention, intern reporting of patient acuity improved from 13% to 92% (P &lt; .001), and gains were maintained 7 months later. Rates of key communication behaviors, such as paraphrasing critical information, did not improve.

Conclusions
A brief educational workshop promoting standardized handovers improved the inclusion of essential information during intern handovers, and these improvements were sustained over time. The intervention did not improve key communication behaviors.
A Novel Survey Tool to Assess Pulmonary and Critical Care Fellows' Attitudes Regarding Acquiring Teaching Skills During Fellowship Training
Authors: Richards Jeremy B. , Kelly Emer , Fessler Henry , Roberts David H. 
Published: July 2013

Abstract

Background
Important components of fellowship training include learning teaching skills and career development. Pulmonary and critical care medicine (PCCM) fellows' opinions of the importance of developing teaching skills and interest in careers in medical education have not been previously described, and there are no tools to assess interest in acquiring teaching skills.

Objective
We describe the development and initial psychometric validation of a survey tool to assess trainees' attitudes toward and interest in acquiring teaching skills.

Methods
A survey tool to assess attitudes toward teaching and medical education skills was designed and psychometrically characterized. We then anonymously surveyed fellows in 1 PCCM program to assess their perceptions of and attitudes regarding acquiring teaching skills.

Results
The survey tool demonstrated acceptable psychometric properties. The survey showed that most fellows felt that acquiring teaching skills was “very important,” and nearly half reported being “interested” or “very interested” in pursuing careers as medical educators. However, fellows disagreed with the feedback they received from attending physicians with regard to their teaching abilities (10% disagreed with feedback at the beginning of the year, 36% disagreed at the end of the year; P  =  .03).

Conclusions
Our survey demonstrates acceptable psychometric properties and performance characteristics in a single-site study of PCCM fellows during 1 academic year. Fellows are interested in improving their teaching skills but do not know how to become better teachers. Added research in multiple settings should explore the generalizability of our findings.
Internal Medicine Postgraduate Training and Assessment of Patient Handoff Skills
Authors: Didwania Aashish , Kriss Michael , Cohen Elaine R. , McGaghie William C. , Wayne Diane B. 
Published: July 2013

Abstract

Background
Effective communication during patient care transitions is essential for high-quality patient care.

Objective
The purpose of this study was (1) to objectively assess patient handoff skills of internal medicine residents, and (2) to evaluate correlations between clinical experience and patient handoff skill self-assessment with directly observed skill.

Methods
We studied simulated patient handoffs in postgraduate year (PGY)-1 and PGY-2 residents between July 2011 and September 2011, using a standardized scenario in an observed structured handoff exam (OSHE). Our design was a posttest-only, with nonequivalent groups. Assessment used a previously published checklist for evaluating handoff skills. Residents were asked about clinical experience with patient handoffs and about their self-confidence in performing a patient handoff independently. We evaluated between-group differences on OSHE checklist performance, patient handoff experience, and self-confidence and used multiple regression analyses to assess the association between performance, experience, and confidence.

Results
Forty-seven PGY-1 residents and 38 PGY-2 residents completed the study. Interrater reliability was substantial (intraclass correlation  =  0.68). There was no significant difference in OSHE performance by PGY-1 residents (mean  =  79%, SD  =  4.6) and PGY-2 residents (mean  =  82%; SD  =  7.6; P  =  .07). The PGY-2 residents were significantly more experienced (P &lt; .001) and confident (P &lt; .001) than PGY-1 residents were, yet clinical experience and self-confidence did not significantly predict OSHE performance.

Conclusions
Clinical experience and self-assessment do not predict skills in simulated patient handoffs, and residents with substantial clinical experience still benefit from further skills development.
Point-of-Care Ultrasound in Internal Medicine: A National Survey of Educational Leadership
Authors: Schnobrich Daniel J. , Gladding Sophie , Olson Andrew P. J. , Duran-Nelson Alisa 
Published: July 2013

Abstract

Background
Ultrasound is a valuable tool in the safe performance of an increasing number of procedures. It has additionally emerged as a powerful instrument for point-of-care assessment by offering internists an opportunity to extend their traditional physical examination.

Objective
This study explored how internal medicine (IM) educators perceive the use of ultrasound for procedures and point-of-care assessments, the extent to which curricula for teaching IM residents ultrasound skills exist, and perceived barriers to teaching its use.

Methods
In February 2012, we administered a 27-question survey to all members of the Association of Program Directors in Internal Medicine, eliciting their opinions about the use of point-of-care ultrasound.

Results
Of 2200 surveys distributed electronically, 234 were returned (a 11% response rate), including 167 by program directors or assistant program directors. Respondents highly rated the usefulness of ultrasound for central-line placement, thoracentesis, paracentesis, and diagnosis of pleural effusions. Evaluation of vena cava and heart, and placement of radial artery catheters received somewhat lower usefulness scores. Forty-five respondents (25%) reported having formal curricula to teach point-of-care ultrasound, and 46 respondents without current ultrasound programs were planning to initiate them in the next 12 months. Potential barriers to teaching and use of ultrasound included the time and cost to train faculty, the cost of ultrasound machines, and the time required to train residents.

Conclusions
Educational leaders in IM view point-of-care ultrasound as a valuable tool in diagnosis and procedures, and many residency programs are teaching these skills to their learners.
Defining Scholarly Activity in Graduate Medical Education
Authors: Grady Erin C. , Roise Adam , Barr Daniel , Lynch Douglas , Lee Katherine Bao-Shian , Daskivich Timothy , Dhand Amar , Butler Paris D. 
Published: July 2013

Abstract

Background
Scholarly activity is a requirement for accreditation by the Accreditation Council for Graduate Medical Education. There is currently no uniform definition used by all Residency Review Committees (RRCs). A total of 6 of the 27 RRCs currently have a rubric or draft of a rubric to evaluate scholarly activity.

Objective
To develop a definition of scholarly activity and a set of rubrics to be used in program accreditation to reduce subjectivity of the evaluation of scholarly activity at the level of individual residency programs and across RRCs.

Methods
We performed a review of the pertinent literature and selected faculty promotion criteria across the United States to develop a structure for a proposed rubric of scholarly activity, drawing on work on scholarship by experts to create a definition of scholarly activity and rubrics for its assessment.

Results
The literature review showed that academic institutions in the United States place emphasis on all 4 major components of Boyer's definition of scholarship: discovery, integration, application, and teaching. We feel that the assessment of scholarly activity should mirror these findings as set forth in our proposed rubric. Our proposed rubric is intended to ensure a more objective evaluation of these components of scholarship in accreditation reviews, and to address both expectations for scholarly pursuits for core teaching faculty and those for resident and fellow physicians.

Conclusion
The aim of our proposed rubric is to ensure a more objective evaluation of these components of scholarship in accreditation reviews, and to address expectations for scholarly pursuits for core teaching faculty as well as those for resident and fellow physicians.
Successful Efforts to Increase Diversity in a Cardiology Fellowship Training Program
Authors: Auseon Alex J. , Kolibash Albert J. , Capers Quinn 
Published: July 2013

Abstract

Background
A large volume of literature has documented racial disparities in the delivery of cardiovascular care in the United States and that decreased access to procedures and undertreatment lead to worse outcomes. A lack of diversity among physicians is considered to be a major contributor. The fellowship training program in cardiovascular medicine at The Ohio State University Medical Center had never trained a fellow from a minority group underrepresented in medicine (URM) before 2007.

Intervention
In 2005, the fellowship made it a priority to recruit and match URM candidates in an effort to address the community's lack of diversity and disparities in cardiovascular care.

Methods
Program leaders revised the recruitment process, making diversity a high priority. Faculty met with members of diverse residency programs during visits to other institutions, the focus of interview day was changed to highlight mentorship, additional targeted postinterview communications reached out to highly competitive applicants, and a regular mentoring program was constructed to allow meaningful interaction with URM faculty and fellows.

Results
Since these changes were implemented, the program has successfully matched a URM fellow for 5 consecutive years. Such candidates currently make up 4 of 16 total trainees (25%) in the fellowship in cardiovascular medicine.

Conclusions
The cardiovascular medicine fellowship training program at The Ohio State University was able to revise recruitment to attract competitive URM applicants as part of a concerted effort. Other educational programs facing similar challenges may be able to learn from the university's experiences.