bluuebunny/crossref_metadata_2025_split huggingface dataset:
Advantages and Challenges of Working as a Clinician in an Academic Department of Medicine: Academic Clinicians' Perspectives
Authors: Christmas Colleen , Durso Samuel C. , Kravet Steven J. , Wright Scott M. 
Published: July 2013

Abstract

Background
The provision of high-quality clinical care is critical to the mission of academic and nonacademic clinical settings and is of foremost importance to academic and nonacademic physicians. Concern has been increasingly raised that the rewards systems at most academic institutions may discourage those with a passion for clinical care over research or teaching from staying in academia. In addition to the advantages afforded by academic institutions, academic physicians may perceive important challenges, disincentives, and limitations to providing excellent clinical care. To better understand these views, we conducted a qualitative study to explore the perspectives of clinical faculty in prominent departments of medicine.

Methods
Between March and May 2007, 2 investigators conducted in-depth, semistructured interviews with 24 clinically excellent internal medicine physicians at 8 academic institutions across the nation. Transcripts were independently coded by 2 investigators and compared for agreement. Content analysis was performed to identify emerging themes.

Results
Twenty interviewees (83%) were associate professors or professors, 33% were women, and participants represented a wide range of internal medicine subspecialties. Mean time currently spent in clinical care by the physicians was 48%. Domains that emerged related to faculty's perception of clinical care in the academic setting included competing obligations, teamwork and collaboration, types of patients and productivity expectations, resources for clinical services, emphasis on discovery, and bureaucratic challenges.

Conclusions
Expert clinicians at academic medical centers perceive barriers to providing excellent patient care related to competing demands on their time, competing academic missions, and bureaucratic challenges. They also believe there are differences in the types of patients seen in academic settings compared with those in the private sector, that there is a “public” nature in their clinical work, that productivity expectations are likely different from those of private practitioners, and that resource allocation both facilitates and limits excellent care in the academic setting. These findings have important implications for patients, learners, and faculty and academic leaders, and suggest challenges as well as opportunities in fostering clinical medicine at academic institutions.
Evaluation of a Case-Based Primary Care Pediatric Conference Curriculum
Authors: Talwalkar Jaideep S. , Fenick Ada M. 
Published: July 2013

AbstractBackgroundOur goal was to assess the impact of a standardized residency curriculum in ambulatory pediatrics on residents' participation, satisfaction, and confidence.MethodsA case-based curriculum for weekly primary care conference was developed to replace the existing free-form review of topics at the Yale Pediatrics Residency Program. Before the curricular switch, faculty preceptors and members of the academic year 2005–2006 intern class completed surveys designed to measure conference occurrence and resident attendance, participation, satisfaction, and confidence in clinical skills. One year after the curricular switch, identical surveys were completed by faculty preceptors and members of the academic year 2006–2007 intern class.ResultsFaculty surveys indicated that conferences took place significantly more often after the curricular switch. The number of residents at conference each day (3.18 vs 4.50; P &lt; .01) and the percentage who actually spoke during conference (45% vs 82%, P &lt; .01) significantly increased. There were 18 demographically similar interns in each of the 2 classes. Members of the academic year 2006–2007 intern class, having trained exclusively with the standardized curriculum, were significantly more likely to respond favorably to survey items about participation, satisfaction, and confidence. In addition, they were more likely to endorse survey items that reflected explicit goals of the standardized curriculum and the Accreditation Council for Graduate Medical Education core competencies.ConclusionImplementation of a structured curriculum for ambulatory care improved interns' self-reported participation, satisfaction, and confidence. The primary care conference occurred more dependably after the curricular change, and improvements in attendance and participation were documented. Pediatric residency programs may make better use of conference time in the ambulatory setting through the use of structured, case-based educational material.
Senior Internal Medicine Residents' Confidence with Essential Topics in Evidence-Based Medicine Taught During Internship
Authors: Keddis Mira T. , Beckman Thomas J. , Cullen Michael W. , Reed Darcy A. , Halvorsen Andrew J. , Wittich Christopher M. , West Colin P. , McDonald Furman S. 
Published: July 2013

Abstract

Background
Few studies have examined residents' retained knowledge and confidence regarding essential evidence-based medicine (EBM) topics.

Objective
To compare postgraduate year-3 (PGY-3) residents' confidence with EBM topics taught during internship with that of PGY-1 residents before and after exposure to an EBM curriculum.

Methods
All residents participated in an EBM curriculum during their intern year. We surveyed residents in 2009. PGY-1 residents completed a Likert-scale type survey (which included questions from the validated Berlin questionnaire and others, developed based on input from local EBM experts). We administered the Berlin questionnaire to a subset of PGY-3 residents.

Results
Forty-five PGY-3 (88%; n  =  51) and 42 PGY-1 (91%; n  =  46) residents completed the survey. Compared with PGY-1 residents pre-curriculum, PGY-3 residents were significantly more confident in their knowledge of pre- and posttest probability (mean difference, 1.14; P  =  .002), number needed to harm (mean difference, 1.09; P  =  .002), likelihood ratio (mean difference, 1.01; P  =  .003), formulation of a focused clinical question (mean difference, 0.98; P  =  .001), and critical appraisal of therapy articles (mean difference, 0.91; P  =  .002). Perceived confidence was significantly lower for PGY-3 than post-curriculum PGY-1 residents on relative risk (mean difference, −0.86; P  =  .002), study design for prognosis questions (mean difference, −0.75; P  =  .004), number needed to harm (mean difference, −0.67; P  =  .01), ability to critically appraise systematic reviews (mean difference, −0.65, P  =  .009), and retrieval of evidence (mean difference, −0.56; P  =  .008), among others. There was no relationship between confidence with and actual knowledge of EBM topics.

Conclusions
Our findings demonstrate lower confidence among PGY-3 than among PGY-1 internal medicine residents for several EBM topics. PGY-3 residents demonstrated poor knowledge of several core topics taught during internship. Longitudinal EBM curricula throughout residency may help reinforce residents' EBM knowledge and their confidence.
Conflict Styles in a Cohort of Graduate Medical Education Administrators, Residents, and Board-Certified Physicians
Authors: Ogunyemi Dotun , Tangchitnob Edward , Mahler Yonathan , Chung Connie , Alexander Carolyn , Korwin Devra 
Published: July 2013

Abstract

Objective
To assess conflict styles and construct validity of the Thomas-Kilmann Mode of Conflict Instrument (TKI) among medical education personnel.

Methods
From 2006 to 2009, 23 board-certified physicians (faculty), 46 residents, and 31 graduate medical education (GME) administrators participated in 3 behavior surveys. We used self-reported data (as completed by participants on the questionnaire). The TKI defines 5 conflict styles: competing, collaborating, compromising, accommodating, and avoiding. The My Best Communication Style Survey assesses 4 styles of communication: bold, expressive, sympathetic, and technical. The Interpersonal Influence Inventory categorizes 4 behavior styles: openly aggressive, assertive, concealed aggressive, and passive behaviors. A P value of &lt; .05 was significant.

Results
Avoiding was the conflict style most chosen, closely followed by compromising and accommodating, whereas collaborating was the least likely to be selected. Collaborating percentiles were highest in GME administrators and lowest in faculty. Competing percentiles decreased from faculty to GME administrators (r  =  −0.237, P  =  .017). Openly aggressive scores were highest in faculty and lowest in GME administrators (P  =  .028). Technical communication scores were highest in residents and lowest in GME administrators (P  =  .008). Technical communication scores were highest in African Americans (P  =  .000). Asian Americans were more likely to be high in accommodating style (P  =  .019). Midwest respondents selected the collaborating style more than others did (41.3% versus 25%) (P  =  .009). Competing conflict style correlated positively with openly aggressive behavior and bold communication but negatively with expressive and sympathetic communications.

Conclusion
There are differences in behavior patterns among faculty, residents, and GME administrators with suggestions of ethnic and geographic influences. Correlation among instruments supported theoretical relationships of construct validity.
Residents' Awareness of Racial and Ethnic Disparities in Cardiovascular Care
Authors: Greysen S. Ryan , Siegel Bruce , Sears Vickie , Solomon Allen , Jones Karen , Bradley Elizabeth H 
Published: July 2013

Abstract

Purpose
To characterize attitudes of residents toward racial/ethnic disparities in health care and to explore the effect of a simple intervention to improve awareness of these disparities.

Methods
The authors surveyed residents in internal and emergency medicine rotating through the Coronary Care Unit of a major teaching hospital about their attitudes toward disparities in cardiovascular care before and after an intervention that fostered discussion of evidence for the existence of disparities, possible causes of disparities, and clinically focused approaches to quality improvement tailored to the residents' practice environment.

Results
Before the intervention, 35% of residents agreed that racial/ethnic disparities might occur for patients within the US health care system in general, and only 7% agreed that patients they personally treated might experience racial/ethnic disparities in healthcare. These proportions increased significantly after the intervention: 85% agreement at level of US health care system and 32% at the level of individual practice (P &lt; .001). Changes in awareness did not differ by sex, postgraduate year of training, race/ethnicity, reported prior diversity training, or plans to subspecialize.

Conclusion
Awareness of racial/ethnic disparities in care among residents remains low, particularly at the level of individual practice, but is amenable to intervention.
Patient Follow-up in an Urban Resident Continuity Clinic: An Initiative to Improve Scheduling Practices
Authors: Dowdy David W. , Horton Claire K. , Lau Ben , Ferrer Rosaly , Chen Alice H. 
Published: July 2013

Abstract

Introduction
Failure to schedule timely follow-up appointments may impair continuity and quality of care, especially for patients with low health literacy and unstable living situations. Resident continuity clinics face particular challenges in scheduling patient follow-up because of residents' complex schedules and limited time in clinic.

Methods
As part of a structured quality-improvement curriculum, residents initiated discussions with clinical supervisors and clerical staff to evaluate and improve scheduling practices in an urban continuity clinic. The problem-solving process emphasized feasibility (rapid implementation/evaluation cycle, low time/resource burden) and measurable outcomes. These discussions led to design of a new scheduling form. We evaluated the short-term impact of awareness raising by comparing scheduling rates before (month 1) versus after (months 2–3) implementation, and of the form itself by randomly selecting 2 afternoon clinics to implement the new form, with a third serving as control.

Results
We analyzed all patient encounters over a 3-month period (n  =  910), excluding patients with a recommended follow-up interval of greater than 4 months. The proportion of appointments “never scheduled” (at 1 month after provider-requested follow-up date) declined from 18.8% (95% confidence interval [CI], 14.5%–23.9%) in month 1 to 11.4% (CI, 8.1%–15.5%) in month 3. This proportion was significantly higher before than after implementation of the form (multivariable relative risk, 1.49; 95% CI, 1.08–2.03; P  =  .02), both in clinics that used and did not use the form (P  =  .93 for difference).

Conclusions
We describe a model resident-led, team-based intervention that addressed core competencies in graduate medical education while improving outpatient scheduling practices.
Developing a Cultural Consensus Analysis Based on the Internal Medicine Milestones (M-CCA)
Authors: Smith C. Scott , Hill William , Francovich Chris , Morris Magdalena , Langlois-Winkle Francine , Caverzagie Kelly , Iobst William 
Published: July 2013

Abstract
A national task force identified domains and developmental milestones from the national competencies for resident training. Cultural Consensus Analysis (CCA) is a standard anthropological technique that can identify value conflicts. We created a CCA based on the internal medicine milestones (M-CCA) in 3 steps: converted the 38 domains into active statements; reduced the total number to 12 by summarizing and combining; and simplified the wording. This M-CCA needs further validation, after which it may be useful for assessing the 6-competency model.
Addressing the Scholarly Activity Requirements for Residents: One Program's Solution
Authors: Carek Peter J , Dickerson Lori M , Diaz Vanessa A , Steyer Terrence E 
Published: July 2013

Abstract

Background
Scholarly activity as a component of residency education is becoming increasingly emphasized by the Accreditation Council for Graduate Medical Education. “Limited or no evidence of resident or faculty scholarly activity” is a common citation given to family medicine residency programs by the Review Committee for Family Medicine.

Objective
The objective was to provide a model scholarly activity curriculum that has been successful in improving the quality of graduate medical education in a family medicine residency program, as evidenced by a record of resident academic presentations and publications.

Methods
We provide a description of the Clinical Scholars Program that has been implemented into the curriculum of the Trident/Medical University of South Carolina Family Medicine Residency Program.

Results
During the most recent 10-year academic period (2000–2010), a total of 111 residents completed training and participated in the Clinical Scholars Program. This program has produced more than 24 presentations during national and international meetings of medical societies and 15 publications in peer-reviewed medical journals. In addition, many of the projects have been presented during meetings of state and regional medical organizations.

Conclusions
This paper presents a model curriculum for teaching about scholarship to family medicine residents. The success of this program is evidenced by the numerous presentations and publications by participating residents.
Efficacy of Peer-Assisted Learning Across Residencies for Procedural Training in Dermatology
Authors: Duran-Nelson Alisa , Baum Karyn D , Weber-Main Anne Marie , Menk Jeremiah 
Published: July 2013

Abstract

Background
With new care models such as the medical home, there is an expanding need for primary care providers to be trained in dermatologic procedures. Yet, many internal medicine residency program graduates feel unprepared to perform these procedures. The aim of this study was to evaluate the effect of a structured peer-assisted learning approach to improve residents' knowledge and skills related to common dermatologic assessment techniques.

Methods
Eight medicine-dermatology resident educators, with a faculty member, facilitated dermatologic procedure workshops for 28 internal medicine and medicine-pediatrics resident learners. Learners completed preworkshop and postworkshop surveys, assessing their knowledge and skill levels as well as the efficacy of the resident educators and the educational value of the workshop as a whole.

Results
All learners were able to properly demonstrate the techniques at the workshop's conclusion. The median sum score of self-reported knowledge increased from 3 to 9.5 (scale, 0–10; P &lt; .001). The median sum score of self-reported skills increased from 10 to 16 (scale, 4–20; P &lt; .001). Resident educators were favorably evaluated by their peers, and 96% of participants rated the experience as being of high educational value.

Conclusion
Peer-assisted learning is effective in teaching dermatologic procedures in graduate medical education. Resident learners found peer-assisted learning to be beneficial and rated their peer teachers highly. Further studies should focus on outcomes in practice, looking at the number of dermatologic procedures performed by learners, as well as the effects on resident educators.
Development of an Institutional Resident Curriculum in Communication Skills
Authors: Joyce Barbara L. , Scher Eric , Steenbergh Timothy , Voutt-Goos Mary J. 
Published: July 2013

Abstract

Objective
We describe a collaboration between the graduate medical education office and the Henry Ford Health System's Office of Clinical Quality and Safety to create an institution-wide communication skills curriculum pertinent to the institution's safety and patient- and family-centered care initiatives.

Methods
A multidisciplinary committee provided oversight for the curriculum design and used sentinel event and other quality and safety data to identify specific target areas. The curriculum consisted of 3 courses: “Informed Consent,” “Sharing Bad News,” and “Disclosure of Unanticipated Events.” Each course included 3 components: a multimedia online module; small group discussions led by the program director that focused on the use of communication scripts; and 2 objective structured clinical examinations (OSCEs) requiring residents to demonstrate use of the communication scripts. All first-year residents (N  =  145) and faculty (N  =  30) from 20 residency programs participated in this initiative. Evaluation of the residents consisted of a self-assessment; the standardized patients' assessment of the residents' performance; and faculty assessment of resident performance with verbal feedback.

Results
Survey data showed that residents found the courses valuable, with residents identifying communication scripts they would use in clinical settings. Focus groups with faculty highlighted that the resident debriefing sessions provided them with insight into a resident's communication skills early in their training.

Conclusion
Our institutional curriculum was developed in a collaborative manner, and used an evidence-based approach to teach communication skills relevant to institutional safety and quality initiatives. Other institutions may wish to adopt our strategy of departmental collaboration and alignment of resident education with institutional initiatives.
A Structured Workshop to Improve the Quality of Resident Discharge Summaries
Authors: Talwalkar Jaideep S. , Ouellette Jason R. , Alston Shawnette , Buller Gregory K. , Cottrell Daniel , Genese Thomas , Vaezy Ali 
Published: July 2013

Abstract

Background
Poor communication at hospital discharge can increase the risk of adverse events. The hospital discharge summary is the most common tool for detailing events related to hospitalization in preparation for postdischarge follow-up, yet deficiencies in discharge summaries have been widely reported. Resident physicians are expected to dictate discharge summaries but receive little formal training in this arena. We hypothesized that implementation of an educational program on chart documentation skills would result in improvements in the quality of hospital discharge summaries in a community hospital internal medicine residency program.

Methods
A monthly, 1-hour workshop was launched in August 2007 to provide consistent and ongoing instruction on chart documentation. Guided by a faculty moderator, residents reviewed 2 randomly selected peer chart notes per session using instruments developed for that purpose. After the workshop had been in place for 2 years, 4 faculty members reviewed 63 randomly selected discharge summaries from spring 2007, spring 2008, and spring 2009 using a 14-item evaluation tool.

Results
Mean scores for 10 of the 14 individual items improved in a stepwise manner during the 3 years of the study. Items related to overall quality of the discharge summary showed statistically significant improvement, as did the portion of the summaries “carbon copied” to the responsible outpatient physician.

Conclusions
The quality of hospital discharge summaries improved following the implementation of a novel, structured program to teach chart documentation skills. Ongoing improvement was seen 1 and 2 years into the program, suggesting that continuing instruction in those skills was beneficial.
Equipping Residents to Address Alcohol and Drug Abuse: The National SBIRT Residency Training Project
Authors: Pringle Janice L. , Kowalchuk Alicia , Meyers Jessica Adams , Seale J. Paul 
Published: July 2013

Abstract

Background
The Screening, Brief Intervention and Referral to Treatment (SBIRT) service for unhealthy alcohol use has been shown to be one of the most cost-effective medical preventive services and has been associated with long-term reductions in alcohol use and health care utilization. Recent studies also indicate that SBIRT reduces illicit drug use. In 2008 and 2009, the Substance Abuse Mental Health Service Administration funded 17 grantees to develop and implement medical residency training programs that teach residents how to provide SBIRT services for individuals with alcohol and drug misuse conditions. This paper presents the curricular activities associated with this initiative.

Methods
We used an online survey delivery application (Qualtrics) to e-mail a survey instrument developed by the project directors of 4 SBIRT residency programs to each residency grantee's director. The survey included both quantitative and qualitative data.

Results
All 17 (100%) grantees responded. Respondents encompassed residency programs in emergency medicine, family medicine, pediatrics, obstetrics-gynecology, psychiatry, surgery, and preventive medicine. Thirteen of 17 (76%) grantee programs used both online and in-person approaches to deliver the curriculum. All 17 grantees incorporated motivational interviewing and validated screening instruments in the curriculum. As of June 2011, 2867 residents had been trained, and project directors reported all residents were incorporating SBIRT into their practices. Consistently mentioned challenges in implementing an SBIRT curriculum included finding time in residents' schedules for the modules and the need for trained faculty to verify resident competence.

Conclusions
The SBIRT initiative has resulted in rapid development of educational programs and a cohort of residents who utilize SBIRT in practice. Skills verification, program dissemination, and sustainability after grant funding ends remain ongoing challenges.