bluuebunny/crossref_metadata_2025_split huggingface dataset:
Educational Excellence in a Crowded Emergency Department: Consensus Recommendations From the Council of Emergency Medicine Residency Directors 2010
Authors: Lin Michelle , Taira Taku , Promes Susan , Regan Linda 
Published: July 2013

Abstract

Objective
Emergency Department (ED) crowding is a major public health problem and one that has not been well studied for its effects on education. The objective of this article was to identify best-practice, consensus recommendations to help emergency medicine (EM) residency programs and faculty maintain educational excellence in an era of ED crowding.

Methods
A geographically diverse group of 37 clinician-educator leaders in EM convened at the 2010 Council of Emergency Medicine Residency Directors Academic Assembly. The participants discussed innovative ideas and solutions to address the many educational challenges that ED crowding poses.

Results
To cope with crowding, the consensus group identified 3 educational domains, focusing on the educator, the learner, and the institutional system. Core subthemes included optimizing teaching opportunities, providing alternative teaching approaches, and redefining what faculty and learners traditionally think of as teaching. An ED rotation provides ample opportunities for teaching not only about patient care and medical knowledge but also other Accreditation Council for Graduate Medical Education competencies, such as interpersonal and communication skills, professionalism, and system-based practice.

Conclusions
Crowding in EDs poses educational challenges, but with some creativity, flexibility, and desire to make the most of a challenging situation, educational excellence is an achievable goal.
Mainstreaming Risk Management Education Into New Resident and Fellow Orientation
Authors: McMyler Eileen T , Ross Paula T , Saran Kelly A , Urteaga-Fuentes Anabel , Anderson Susan G , Boothman Richard C , Lypson Monica L 
Published: July 2013

Abstract

Introduction
Understanding patient safety events and causative factors is an important step in reducing preventable adverse events. The University of Michigan's Graduate Medical Education (GME) Office, Department of Risk Management (DRM), and Office of Clinical Affairs (OCA) collaborated to incorporate a video workshop as a formal introduction to patient safety during orientation for new residents and fellows. This workshop reinforced the importance of effective communication and supervision in patient safety.

Methods
DRM and OCA produced a video depicting an actual, unanticipated outcome that resulted from a constellation of preventable circumstances, which allows the audience to observe communication and supervision issues that lead to a patient death. The video is followed by a discussion of the patient safety issues seen, why they occurred, and strategies for improvement. Trainee perceptions of the value of the experience were surveyed and collected using a qualitative survey.

Results
Most responders found the video workshop helpful. Trainees perceived the video and facilitated discussion as an effective way to identify patient safety issues, available resources, and the culture of patient safety at the institution.

Conclusion
Trainee comments supported the video workshop as an effective way to highlight the importance of communication and supervision in relation to patient safety. In the future, the DRM, OCA, and GME hope to reinforce this shared vision of patient safety through combined educational efforts.
Progress Toward Improving the Quality of Cardiac Arrest Medical Team Responses at an Academic Teaching Hospital
Authors: Didwania Aashish , McGaghie William C. , Cohen Elaine R. , Butter John , Barsuk Jeffrey H. , Wade Leonard D. , Chester Rozanna , Wayne Diane B. 
Published: July 2013

Abstract

Background
Internal medicine (IM) residents who undergo simulation-based advanced cardiac life support (ACLS) training are significantly more likely to manage actual events according to American Heart Association (AHA) standards than nontrained residents. How long ACLS skills are retained is unknown.

Methods
We conducted a retrospective case-control study of ACLS responses from January to June 2008 and reviewed medical records to assess adherence to AHA standards. Cases and controls are team responses to ACLS events divided into those directed by postgraduate year 2 (PGY-2) IM resident leaders versus those managed by PGY-3 IM resident leaders. Residents in 2008 completed an educational program featuring deliberate practice in ACLS using a human patient simulator during their second year. Medical records of ACLS events were reviewed to assess adherence to AHA guidelines. We evaluated the effects of simulation training on quality of ACLS care during the 2008 period and in comparison with historical 2004 data.

Results
In 2008, 1 year after simulation training, PGY-3 residents showed the same adherence to AHA standards (88% [SD, 17%]) as that of PGY-2 residents who were newly simulator trained (86% [SD, 18%]) (P  =  .77). Previously, in 2004, PGY-2 simulator-trained residents showed significantly higher adherence to AHA standards (68% [SD, 20%]) than nonsimulator-trained PGY-3 residents (44% [SD, 20%]) (P &lt; .001). All resident groups in 2008 outperformed their 2004 peers.

Conclusions
Improved quality of ACLS care was maintained by 2008 PGY-3 simulator-trained residents 1 year after training, likely due to skill retention rather than increased clinical experience, as a prior cohort of PGY-3 residents did not perform as well as PGY-2 residents in actual ACLS care. Our results confirm prior work regarding the impact of simulation-based education to improve the quality of actual patient care.
Pediatric Residents' Learning Styles and Temperaments and Their Relationships to Standardized Test Scores
Authors: Tuli Sanjeev Y. , Thompson Lindsay A. , Saliba Heidi , Black Erik W. , Ryan Kathleen A. , Kelly Maria N. , Novak Maureen , Mellott Jane , Tuli Sonal S. 
Published: July 2013

Abstract

Background
Board certification is an important professional qualification and a prerequisite for credentialing, and the Accreditation Council for Graduate Medical Education (ACGME) assesses board certification rates as a component of residency program effectiveness. To date, research has shown that preresidency measures, including National Board of Medical Examiners scores, Alpha Omega Alpha Honor Medical Society membership, or medical school grades poorly predict postresidency board examination scores. However, learning styles and temperament have been identified as factors that may affect test-taking performance. The purpose of this study is to characterize the learning styles and temperaments of pediatric residents and to evaluate their relationships to yearly in-service and postresidency board examination scores.

Methods
This cross-sectional study analyzed the learning styles and temperaments of current and past pediatric residents by administration of 3 validated tools: the Kolb Learning Style Inventory, the Keirsey Temperament Sorter, and the Felder-Silverman Learning Style test. These results were compared with known, normative, general and medical population data and evaluated for correlation to in-service examination and postresidency board examination scores.

Results
The predominant learning style for pediatric residents was converging 44% (33 of 75 residents) and the predominant temperament was guardian 61% (34 of 56 residents). The learning style and temperament distribution of the residents was significantly different from published population data (P  =  .002 and .04, respectively). Learning styles, with one exception, were found to be unrelated to standardized test scores.

Conclusions
The predominant learning style and temperament of pediatric residents is significantly different than that of the populations of general and medical trainees. However, learning styles and temperament do not predict outcomes on standardized in-service and board examinations in pediatric residents.
Pediatrics Milestone Project: Next Steps Toward Meaningful Outcomes Assessment
Authors: Hicks Patricia J. , Englander Robert , Schumacher Daniel J. , Burke Ann , Benson Bradley J. , Guralnick Susan , Ludwig Stephen , Carraccio Carol 
Published: July 2013

AbstractIn the September 2010 issue of JGME, the Pediatric Milestones Working Group published “The Pediatrics Milestones: Conceptual Framework, Guiding Principles, and Approach to Development”, a document that describes the construction of the first iteration of the Pediatric Milestones. These Milestones were developed by the Working Group as a group of practical behavioral expectations for each of the 52 sub-competencies. In constructing these Milestones, the authors were cognizant of the need to ground the Milestones themselves in evidence, theories or other conceptual frameworks that would provide the basis for the ontogeny of development for each sub-competency. During this next phase of the Milestones development, the process will continue with consultation with content experts and consideration of assessment of Milestones. We have described possible measurement tools, explored threats to validity, establishment of benchmarks, and possible approaches to reporting of performance. The vision of the Pediatrics Milestone Project is to understand the development of a pediatrician from entry into medical school through the twilight of a physician’s career, and the work will require a collaborative effort of the undergraduate and graduate medical education communities, and the accrediting and certifying bodies.
Feasibility of an Internet-Based Global Ranking Instrument
Authors: Mudumbai Seshadri C , Gaba David M , Boulet John , Howard Steven K , Davies M. Frances 
Published: July 2013

Abstract

Background
Single-item global ratings are commonly used at the end of undergraduate clerkships and residency rotations to measure specific competencies and/or to compare the performances of individuals against their peers. We hypothesized that an Internet-based instrument would be feasible to adequately distinguish high- and low-ability residents.

Materials and Methods
After receiving Institutional Review Board approval, we developed an Internet-based global ranking instrument to rank 42 third-year residents (21 in 2008 and 21 in 2009) in a major university teaching hospital's department of anesthesiology. Evaluators were anesthesia attendings and nonphysicians in 3 tertiary-referral hospitals. Evaluators were asked this ranking question: “When it comes to overall clinical ability, how does this individual compare to all their peers?”

Results
For 2008, 111 evaluators completed the ranking exercise; for 2009, 79 completed it. Residents were rank-ordered using the median of evaluator categorizations and the frequency of ratings per assigned relative performance quintile. Across evaluator groups and study years, the summary evaluation data consistently distinguished the top and bottom resident cohorts.

Discussion
An Internet-based instrument, using a single-item global ranking, demonstrated feasibility and can be used to differentiate top- and bottom-performing cohorts. Although ranking individuals yields norm-referenced measures of ability, successfully identifying poorly performing residents using online technologies is efficient and will be useful in developing and administering targeted evaluation and remediation programs.
Incoming Resident Interest in Global Health: Occasional Travel Versus A Future Career Abroad?
Authors: Birnberg Jonathan M , Lypson Monica , Anderson R. Andy , Theodosis Christian , Kim Jimin , Olopade Olufunmilayo I , Arora Vineet M 
Published: July 2013

Abstract

Background
While there is growing interest among residents in participating in international health experiences, it is unclear whether this interest will translate into intentions to pursue a global health career. We aimed to describe overall interest in and career intentions toward global health among interns.

Methods
We administered an anonymous survey to incoming interns in all specializations during graduate medical education orientation at 3 teaching hospitals affiliated with 2 Midwestern US medical schools in June 2009. Survey domains included demographics, previous global health experiences, interest in and barriers to participating in global health experiences during residency, and plans to pursue a future global health career.

Results
Response rate was 87% (299 of 345 residents). The most commonly reported barriers to participating in global health experiences were scheduling (82%) and financial (80%) concerns. Two-thirds of interns (65%) reported they were likely to focus on global health in their future career. Of those envisioning a global health career, 77% of interns reported interest in participating in short, occasional trips in the future; and 23% of interns intended to pursue a part-time or full-time career abroad. Interns committed to a career abroad were more willing to use vacation time (73% vs. 40% of all others, respectively; P &lt; .001) or to personally finance the trip (58% vs. 27% of all others, respectively; P  =  &lt; .001), and were less concerned about personal safety than interns not committed (9% vs. 26% of all others, respectively; P  =  .01).

Conclusions
Although a large proportion of incoming interns report interest in global health careers, few are committed to a global health career. Medical educators could acknowledge career plans in global health when developing global health curricula.
The Impact of ACGME Work-Hour Reforms on the Operative Experience of Fellows in Surgical Subspecialty Programs
Authors: Simien Christopher , Holt Kathleen D , Richter Thomas H 
Published: July 2013

Abstract

Background
In July 2003, the Accreditation Council for Graduate Medical Education (ACGME) introduced a set of regulations that mandated a reduction in the number of hours that medical residents can work. These requirements have generated controversy among medical educators, with some expressing concern that reducing resident hours may limit clinical exposure and competency, particularly in surgical specialties.

Objective
This study examines the impact of duty hour restrictions on resident operative experience in residents in 2 surgical subspecialties since the implementation of the ACGME duty hour limits.

Method
We examined operative log data for vascular surgery and pediatric surgery, using the academic year immediately preceding the duty hour restrictions, 2002 to 2003, as a baseline for comparison to subsequent academic years through 2006 to 2007 for vascular surgery and 2007 to 2008 for pediatric surgery.

Results
Graduating fellows in pediatric surgery showed no change in their total operative volume following duty hour restrictions. The pediatric-defined category of neonate procedures showed an increase following duty hour restrictions. Graduating fellows in vascular surgery showed an increase in total major procedures as surgeon. The vascular-defined categories of endovascular-diagnostic, endovascular-therapeutic, and endovascular-graft procedures also increased.

Conclusions
The reduction of duty hours has not resulted in a decrease in operative volume as some have predicted. Operative volume in pediatric surgery remained mainly unchanged, whereas operative volume in vascular surgery increased. We explore possible explanations for the observed findings.
Using a Web-Based Survey for the Annual Internal Medicine Residency Evaluation
Authors: Ethnasios Ramez , Rotblatt Michael , Wali Soma 
Published: July 2013

Abstract

Background
The Accreditation Council for Graduate Medical Education requires annual surveys of residency programs.

Intervention
We switched from a paper-based to a web-based survey and report on the efficiency and quality improvement gains from this change. To determine the prevalence of web-based surveys, we conducted a web-based and telephone survey of 17 internal medicine residency training programs in Southern California. Fifteen programs provided data (88% response rate).

Results
By making the switch, our internal medicine residency program was able to save over 50 administrative hours and over 1000 pieces of paper. A total investment of $20 for the Surveymonkey.com account (Palo Alto, CA) and approximately 15 hours to migrate the survey was made. The program administrators were able to more rapidly analyze and respond to the feedback from the residents with this system. Our survey of other programs showed that of 15 programs, 12 used a web-based survey system (80%) and 3 used a paper-based system (20%). Surveymonkey.com was the most popular system used.

Conclusions
We feel that the quality of response to resident feedback was enhanced by the real-time reaction to comments and assessments. Residents also appreciated the benefits of such a change. We recommend this approach to other programs that are still using paper-based surveys.
Graduate Medical Education Leadership Development Curriculum for Program Directors
Authors: Haan Constance K. , Zenni Elisa A. , West Denise T. , Genuardi Frank J. 
Published: July 2013

Abstract

Objective
Program director (PD) orientation to roles and responsibilities takes on many forms and processes. This article describes one institution's innovative arm of faculty development directed specifically toward PDs and associate PDs to provide institutional resources and information for those in graduate medical education leadership roles.

Methods
The designated institutional official created a separate faculty development curriculum for leadership development of PDs and associate PDs, modeled on the Association of American Medical Colleges-GRA (Group on Resident Affairs) graduate medical education leadership development course for designated institutional officials. It consists of monthly 90-minute sessions at the end of a working day, for new and experienced PDs alike, with mentoring provided by experienced PDs. We describe 2 iterations of the curriculum. To provide ongoing support a longitudinal curriculum of special topics has followed in the interval between core curriculum offerings.

Results
Communication between PDs across disciplines has improved. The broad, inclusive nature allowed for experienced PDs to take advantage of the learning opportunity while providing exchange and mentorship through sharing of lessons learned. The participants rated the course highly and education process and outcome measures for the programs have been positive, including increased accreditation cycle lengths.

Conclusion
It is important and valuable to provide PDs and associate PDs with administrative leadership development and resources, separate from general faculty development, to meet their role-specific needs for orientation and development and to better equip them to meet graduate medical education leadership challenges. This endeavor provides a foundational platform for designated institutional official and PD interactions to work on program building and improvement.
The Importance of International Medical Rotations in Selection of an Otolaryngology Residency
Authors: Boyd Nathan H , Cruz Raul M 
Published: July 2013

Abstract

Background
The objective of this study was to determine the extent of interest in international electives among prospective otolaryngology residents and to determine whether the availability of international electives affected students' interest in ranking a particular residency program.

Methods
A 3-part survey was given to all medical students enrolled in the 2008 otolaryngology match via the Electronic Residency Application Service. Part 1 elicited demographic information. Part 2 explored general interest in international rotations. Part 3 involved ranking several factors affecting students' choice of residency programs. This survey was developed at our institution, with no formal validation. Participation was anonymous and voluntary.

Results
A total of 307 students entered the otolaryngology match, and 55 surveys (18%) were completed. Twenty-five of 55 students (55%) had completed an international elective during or prior to medical school, and 51 of 55 respondents (93%) had a “strong” or “very strong” desire to participate in an international elective during residency; 48 of 55 students (87%) had a “strong” or “very strong” desire to participate in international surgical missions after residency. Future practice goals had no correlation with interest in international rotations, either during or after residency training. Respondents ranked 8 factors that had an impact on residency program selection in the following order of importance: operative experience, location, lifestyle, research opportunities, didactics, international electives, prestige of program, and salary.

Conclusion
Interest in international medicine among prospective otolaryngologists was high in this subset of respondents but did not appear to affect residency program selection.
Missed Appointments in Resident Continuity Clinic: Patient Characteristics and Health Care Outcomes
Authors: Nguyen Douglas L , DeJesus Ramona S , Wieland Mark L 
Published: July 2013

AbstractBackgroundFrequent missed patient appointments in resident continuity clinic is a well-documented problem, but whether rates of missed appointments are disproportionate to standard academic practice, what patient factors contribute to these differences, and health care outcomes of patients who frequently miss appointments are unclear.MethodsThe overall population for the study was composed of patients in an academic internal medicine continuity clinic with 5 or more office visits between January 2006 and December 2008. We randomly selected 325 patients seen by resident physicians and 325 patients cared for by faculty. Multivariate linear regression was used to examine the relationship between patient factors and missed appointments. Health outcomes were compared between patients with frequent missed appointments and the remainder of the study sample, using Cox regression analysis.ResultsResident patients demonstrated significantly higher rates of missed appointments than faculty patients, but this difference was explained by patient factors. Factors associated with more missed appointments included use of a medical interpreter, Medicaid insurance, more frequent emergency department visits, less time impanelled in the practice, and lower proportion of office visits with the primary care provider. Patients with frequent missed appointments were less likely to be up to date with preventive health services and more likely to have poorly controlled blood pressure and diabetes.ConclusionsWe found that the disproportionate frequency of missed appointments in resident continuity clinic is explained by patient factors and practice discontinuity, and that patients with frequent missed appointments demonstrated worse health care outcomes.