bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changing the Formula of Residents' Work Hours in Internal Medicine: Moving From “Years in Training” to “Hours in Training”
Authors: Mansi Ishak A 
Published: July 2013

Abstract

Background
In a recent report, the Institute of Medicine recommended more restrictions on residents' working hours. Several problems exist with a system that places a weekly limit on resident duty hours: (1) it assumes the presence of a linear relationship between hours of work and patient safety; (2) it fails to consider differences in intensity among programs; and (3) it does not address increases in the scientific content of medicine, and it places the burden of enforcing the duty hour limits on the Accreditation Council for Graduate Medical Education.

Proposal
An innovative method of calculating credit hours for graduate medical education would shift the focus from “years of residency” to “hours of residency.” For example, internal medicine residents would be requested to spend 8640 hours of total training hours (assuming 60 hours per week for 48 weeks annually) instead of the traditional 3 years. This method of counting training hours is used by other professions, such as the Intern Development Program of the National Council of Architectural Registration Boards. The proposed approach would allow residents and program directors to pace training based on individual capabilities. Standards for resident education should include the average number of patients treated in each setting (inpatient or outpatient). A possible set of “multipliers” based on these parameters, and possibly others such as resident evaluation, is devised to calculate the “final adjusted accredited hours” that count toward graduation.

Anticipated Benefits
Substituting “years of training” with “hours of training” may resolve many of the concerns with the current residency education model, as well as adapt to the demands of residents' personal lives. It also may allow residents to pace their training according to their capabilities and learning styles, and contribute to reflective learning and better quality education.
Competence in Patient Safety: A Multifaceted Experiential Educational Intervention for Resident Physicians
Authors: Lukela Michael P , Parekh Vikas I , Gosbee John W , Purkiss Joel A , Valle John Del , Mangrulkar Rajesh S 
Published: July 2013

Abstract

Background
The need to provide efficient, effective, and safe patient care is of paramount importance. However, most physicians receive little or no formal training to prepare them to address patient safety challenges within their clinical practice.

Methods
We describe a comprehensive Patient Safety Learning Program (PSLP) for internal medicine and medicine-pediatrics residents. The curriculum is designed to teach residents key concepts of patient safety and provided opportunities to apply these concepts in the “real” world in an effort to positively transform patient care. Residents were assigned to faculty expert-led teams and worked longitudinally to identify and address patient safety conditions and problems. The PSLP was assessed by using multiple methods.

Results
Resident team-based projects resulted in changes in several patient care processes, with the potential to improve clinical outcomes. However, faculty evaluations of residents were lower for the Patient Safety Improvement Project rotation than for other rotations. Comments on “unsatisfactory” evaluations noted lack of teamwork, project participation, and/or responsiveness to faculty communication. Participation in the PSLP did not change resident or faculty attitudes toward patient safety, as measured by a comprehensive survey, although there was a slight increase in comfort with discussing medical errors.

Conclusions
Development of the PSLP was intended to create a supportive environment to enhance resident education and involve residents in patient safety initiatives, but it produced lower faculty evaluations of resident for communication and professionalism and did not have the intended positive effect on resident or faculty attitudes about patient safety. Further research is needed to design or refine interventions that will develop more proactive resident learners and shift the culture to a focus on patient safety.
Use of Ecological Momentary Assessment to Guide Curricular Change in Graduate Medical Education
Authors: Willett Lisa L. , Estrada Carlos A. , Wall Terry C. , Coley Heather L. , Ngu Julius , Curry William , Salanitro Amanda , Houston Thomas K. 
Published: July 2013

Abstract

Purpose
To assess whether a novel evaluation tool could guide curricular change in an internal medicine residency program.

Method
The authors developed an 8-item Ecological Momentary Assessment tool and collected daily evaluations from residents of the relative educational value of 3 differing ambulatory morning report formats (scale: 8  =  best, 0  =  worst). From the evaluations, they made a targeted curricular change and used the tool to assess its impact.

Results
Residents completed 1388 evaluation cards for 223 sessions over 32 months, with a response rate of 75.3%. At baseline, there was a decline in perceived educational value with advancing postgraduate (PGY) year for the overall mean score (PGY-1, 7.4; PGY-2, 7.2; PGY-3, 7.0; P &lt; .01) and for percentage reporting greater than 2 new things learned (PGY-1, 77%; PGY-2, 66%; PGY-3, 50%; P &lt; .001). The authors replaced the format of a lower scoring session with one of higher cognitive content to target upper-level residents. The new session's mean score improved (7.1 to 7.4; P  =  .03); the adjusted odds ratios before and after the change for percentage answering, “Yes, definitely” to “Area I need to improve” was 2.53 (95% confidence interval [CI], 1.45–4.42; P  =  .001) and to “Would recommend to others,” it was 2.08 (95% CI, 1.12–3.89; P  =  .05).

Conclusions
The Ecological Momentary Assessment tool successfully guided ambulatory morning report curricular changes and confirmed successful curricular impact. Ecological Momentary Assessment concepts of multiple, frequent, timely evaluations can be successfully applied in residency curriculum redesign.
Addressing Core Competencies Through Hospital Quality Improvement Activities: Attitudes and Engagement
Authors: Lipstein Ellen A , Kronman Matthew P , Richmond Camilla , White Kristin Nyweide , Shugerman Richard P , McPhillips Heather A 
Published: July 2013

Abstract

Background
Hospital quality improvement initiatives are becoming increasingly common. Little is known about the influence of these initiatives on resident learning and attitudes. Our objective was to assess whether training in a hospital committed to involving residents in hospital-initiated, continuous quality improvement (CQI), and to participation in such activities, would influence residents' attitudes toward CQI and engagement in the hospital community.

Methods
We surveyed Seattle Children's Hospital pediatric residents, from residency graduation years 2002–2009. We included questions about participation in quality improvement activities during residency and measures of attitude toward CQI and of workplace engagement. We used descriptive statistics to assess trends in resident participation in hospital CQI activities, attitudes toward CQI and workplace engagement.

Results
The overall response rate was 84% (162 of 194). Among graduated residents, there was a significant trend toward increased participation in CQI activities (P  =  .03). We found no difference in attitude toward CQI between those who had and those who had not participated in such activities nor between residents who began training before and those who began after the hospital formally committed to CQI. Sixty-three percent of residents (25 of 40) who participated in CQI activities were engaged in the hospital community compared with 53% (57 of 107) who did not participate in CQI activities (P  =  .21).

Conclusions
Training in a hospital committed to involving residents in CQI was associated with a high rate of participation in CQI activities. Although such training and participation in CQI were not associated with resident attitudes toward CQI or hospital engagement, it may allow residents to learn skills for practice-based learning and improvement and systems-based practice.
Internal Medicine Physicians' Knowledge of Health Care Charges
Authors: Tek Sehgal Raj , Gorman Paul 
Published: July 2013

AbstractBackgroundConcerns over the rising costs of health care have increased interest in educating residents about the cost impact of medical decisions. While many programs educate residents about the effectiveness of care, little is known about how well residents and faculty know charges of diagnostic tests or both groups' interest in this topic.MethodsWe surveyed internal medicine residents and faculty at an academic tertiary care hospital. Both groups rated their agreement with a series of statements about health care charges on a Likert scale of 1 (strongly disagree) to 9 (strongly agree), and they estimated the charges for 15 commonly ordered diagnostic tests. Estimates within 25% of the true charge were considered correct. The Wilcoxon rank sum test was used to compare responses between residents and faculty.ResultsSeventy of 126 eligible participants (56%) returned surveys. Participants showed poor knowledge of health care charges but expressed a desire to learn more. Physicians also felt that cost-effectiveness should be considered when ordering diagnostic tests, although faculty members felt more strongly about this than did residents. In estimating the charges for diagnostic tests, less than a quarter of all responses were within 25% of the true charge.ConclusionsInternal medicine physicians poorly estimate the charges for diagnostic tests but have a strong desire to improve their knowledge, suggesting a possible intervention to improve the cost-effectiveness of medical care.
Learning Clinical Versus Leadership Competencies in the Emergency Department: Strategies, Challenges, and Supports of Emergency Medicine Residents
Authors: Goldman Ellen F , Plack Margaret M , Roche Colleen N , Smith Jeffrey P , Turley Catherine L 
Published: July 2013

AbstractBackgroundEmergency medicine residents are expected to master 6 competencies that include clinical and leadership skills. To date, studies have focused primarily on teaching strategies, for example, what attending physicians should do to help residents learn. Residents' own contributions to the learning process remain largely unexplored. The purpose of this study was to explore what emergency medicine residents believe helps them learn the skills required for practice in the emergency department.MethodsThis qualitative study used semistructured interviews with emergency medicine residents at a major academic medical center. Twelve residents participated, and 11 additional residents formed a validation group. We used phenomenologic techniques to guide the data analysis and techniques such as triangulation and member checks to ensure the validity of the findings.ResultsWe found major differences in the strategies residents used to learn clinical versus leadership skills. Clinical skill learning was approached with rigor and involved a large number of other physicians, while leadership skill learning was unplanned and largely relied on nursing personnel. In addition, with each type of skills, different aspects of the residents' personalities, motivation, and past nonclinical experiences supported or challenged their learning process.ConclusionThe approaches to learning leadership skills are not well developed among emergency medicine residents and result in a narrow perspective on leadership. This may be because of the lack of formal leadership training in medical school and residency, or it may reflect assumptions regarding how leadership skills develop. Substantial opportunity exists for enhancing emergency medicine residents' learning of leadership skills as well as the teaching of these skills by the attending physicians and nurses who facilitate their learning.
Global Health Training During Residency: The Weill Cornell Tanzania Experience
Authors: Hau Duncan K , DiPace Jennifer I , Peck Robert N , Johnson Warren D 
Published: July 2013

Abstract

Background
In 2007, Weill Cornell Medical College (WCMC) began annually to send approximately 30 residents in internal medicine and pediatrics to Bugando Medical Center in Mwanza, Tanzania, where they were supervised and mentored by 2 full-time WCMC faculty physicians.

Objective
To describe the components of the WCMC global health elective and to evaluate the experiences of the participants.

Methods
Subjects were WCMC residents in internal medicine and pediatrics from the graduating classes of 2007–2009. Electronic surveys were sent to all participants (n  = 57) and to a group of nonparticipants (n  =  57).

Results
Overall response rate was 58%. The most-selected, primary reasons for participation in the program were an interest in global health and a desire to serve an underprivileged population. Participants rated use of routine laboratory tests in the United States as more overused than did nonparticipants (P  =  .01). After the elective, 62% of participants reported a reduced use of laboratory and/or radiologic tests. All participants (100%; 39 of 39) reported the elective as having a positive effect on their knowledge of international health and tropical medicine. More than 90% of participants (36 of 39) reported the elective as having a positive effect on their physical examination skills.

Conclusions
Participants of the WCMC global health elective report positive experiences from our multidimensional global health collaboration.
Educating Generalists: Factors of Resident Continuity Clinic Associated With Perceived Impact on Choosing a Generalist Career
Authors: Laponis Ryan , O'Sullivan Patricia S. , Hollander Harry , Cornett Patricia , Julian Katherine 
Published: July 2013

Abstract

Background
Fewer residents are choosing general internal medicine (GIM) careers, and their choice may be influenced by the continuity clinic experience during residency. We sought to explore the relationship between resident satisfaction with the continuity clinic experience and expressed interest in pursuing a GIM career.

Methods
We surveyed internal medicine residents by using the Veterans Health Administration Office of Academic Affiliations Learners' Perceptions Survey—a 76-item instrument with established reliability and validity that measures satisfaction with faculty interactions, and learning, working, clinical, and physical environments, and personal experience. We identified 15 reliable subscales within the survey and asked participants whether their experience would prompt them to consider future employment opportunities in GIM. We examined the association between satisfaction measures and future GIM interest with 1-way analyses of variance followed by Student-Newman-Keuls post hoc tests.

Results
Of 217 residents, 90 (41%) completed the survey. Residents felt continuity clinic influenced career choice, with 22% more likely to choose a GIM career and 43% less likely. Those more likely to choose a GIM career had higher satisfaction with the learning (P  =  .001) and clinical (P  =  .002) environments and personal experience (P &lt; .001). They also had higher satisfaction with learning processes (P  =  .002), patient diversity (P &lt; .001), coordination of care (P  =  .009), workflow (P  =  .001), professional/personal satisfaction (P &lt; .001), and work/life balance (P &lt; .001).

Conclusions
The continuity clinic experience may influence residents' GIM career choice. Residents who indicate they are more likely to pursue GIM based on that clinical experience have higher levels of satisfaction. Further prospective data are needed to assess if changes in continuity clinic toward these particular factors can enhance career choice.
Neonatal Resuscitation Skills Among Pediatricians and Family Physicians: Is Residency Training Preparing for Postresidency Practice?
Authors: Wood Amy M. , Jones M. Douglas , Wood James H. , Pan Zhaoxing , Parker Thomas A. 
Published: July 2013

AbstractBackgroundPediatricians and family physicians are responsible for providing newborn resuscitation, yet Accreditation Council for Graduate Medical Education requirements for training in this area during residency differ markedly for the two specialties. Our objectives were to determine (1) the extent to which neonatal resuscitation training differs for pediatric and family medicine residents; (2) the extent to which general pediatricians and family physicians engage in newborn resuscitation in their practice; and (3) whether use of resuscitation skills differs between urban/suburban and rural providers.MethodsWe surveyed a national cohort of pediatricians and family physicians who obtained board certification between 2001 and 2005. Data were analyzed based on type of physician and setting of current practice.ResultsSurvey response rate was 22% (382 of 1736). Compared with family medicine physicians, pediatricians received more neonatal resuscitation training during residency. Most members of both groups had attended no deliveries in the year prior to the survey (75% [111 of 148] versus 74% [114 of 154]). In their current practice, the groups were equally likely to have provided a newborn bag and mask ventilation, chest compressions, and resuscitation medications. Pediatricians were more likely than family physicians to have attempted to either intubate a newborn (20% [28 of 148] versus 10% [16 of 153]; P  =  .0495) or insert umbilical catheters (15% [22 of 148] versus 5% [8 of 153]; P  =  .005). Regardless of specialty, rural physicians were much more likely to report that they attended deliveries (61% [41 of 67] versus 15% [36 of 234]; P &lt; .001). Among rural pediatricians attending deliveries, 44% (7 of 16) reported feeling inadequately prepared for at least one delivery in the past year.ConclusionsFew primary care pediatricians and family physicians provide newborn resuscitation after residency. For those who do attend deliveries, current training may provide insufficient preparation. Flexible, individualized residency curricula could target intensive resuscitation training to individuals who plan to practice in rural areas and/or attend deliveries after graduation.
The Utility of Letters of Recommendation in Predicting Resident Success: Can the ACGME Competencies Help?
Authors: Stohl Hindi E , Hueppchen Nancy A , Bienstock Jessica L 
Published: July 2013

Abstract

Background
The Accreditation Council for Graduate Medical Education (ACGME) core competencies are used to assess resident performance, and recently similar competencies have become an accepted framework for evaluating medical student achievements as well. However, the utility of incorporating the competencies into the resident application has not yet been assessed.

Purpose
The objective of this study was to examine letters of recommendation (LORs) to identify ACGME competency–based themes that might help distinguish the least successful from the most successful residents.

Methods
Residents entering a university-based residency program from 1994 to 2004 were retrospectively evaluated by faculty and ranked in 4 groups according to perceived level of success. Applications from residents in the highest and lowest groups were abstracted. LORs were qualitatively reviewed and analyzed for 9 themes (6 ACGME core competencies and 3 additional performance measures). The mean number of times each theme was mentioned was calculated for each student. Groups were compared using the χ2 test and the Student t test.

Results
Seventy-five residents were eligible for analysis, and 29 residents were ranked in the highest and lowest groups. Baseline demographics and number of LORs did not differ between the two groups. Successful residents had statistically significantly more comments about excellence in the competency areas of patient care, medical knowledge, and interpersonal and communication skills.

Conclusion
LORs can provide useful clues to differentiate between students who are likely to become the least versus the most successful residency program graduates. Greater usage of the ACGME core competencies within LORs may be beneficial.
The Effect of Bedside Presentations in the Emergency Department on Patient Satisfaction
Authors: Schranz Craig I. , Sobehart Robert J. , Fallgatter Kiva , Riffenburgh Robert H. , Matteucci Michael J. 
Published: July 2013

Abstract

Background
Due to increasing time constraints, the use of bedside presentations in resident education has declined. We examined whether patient satisfaction in the emergency department is affected when first-year residents present at the bedside with attendings.

Methods
We performed an observational, prospective, nonblinded study in the emergency department of a military teaching hospital. We alternately assigned first-year residents to present a convenience sample of 248 patients to the attending physician at the patient's bedside or away from the patient. We measured patient satisfaction by using the Patient Satisfaction Questionaire-18 (PSQ-18), a validated survey instrument that utilizes a Likert scale, and additional nonvalidated survey questions involving Likert and visual analog scales.

Results
While the median PSQ-18 score of 74 (95% confidence interval [CI], 72–76) was higher for patient satisfaction when residents made bedside presentations than that for standard presentations, 72 (95% CI, 70–74), the difference did not reach statistical significance (P  =  .33).

Conclusion
There was no significant difference in overall patient satisfaction between residents' bedside presentations and presentations to attendings away from the patient. Although not significant, the differences noted in PSQ-18 subscales of communication, general satisfaction, and interpersonal manner warrant further investigation. Patients did not appear to be uncomfortable with having their care discussed and with having subsequent resident education at the bedside. Future research on patient satisfaction after implementation of standardized bedside teaching techniques may help further elucidate this relationship.
Training Residents to Address Cancer Health Disparities
Authors: Taylor Beverly D. , Buckner Ayanna V. , Walker Carla Durham , Azonobi Ijeoma 
Published: July 2013

Abstract

Introduction
Cancer is the source of significant morbidity and mortality in the United States, and eliminating cancer-related racial and ethnic disparities has become an ever-increasing focus of public health efforts. Increasing workforce diversity plays a major role in the reduction of health disparities, and a well-trained professional workforce is essential for the prevention, control, and ultimate elimination of this disease.

Methods
To help address this need, the Public Health/General Preventive Medicine residency program at Morehouse School of Medicine (MSM) developed an innovative Cancer Prevention and Control Track (CPCT). We describe the structure of the track, funding, examples of resident activities, and program successes.

Results
Since the development of the track in 2007, there have been 3 graduates, and 2 residents are currently enrolled. Residents have conducted research projects and have engaged in longitudinal community-based activities, cancer-focused academic experiences, and practicum rotations. There have been 3 presentations at national meetings, 1 research grant submitted, and 1 research award.

Conclusion
The CPCT provides residents with comprehensive cancer prevention and control training with emphasis in community engagement, service, and research. It builds on the strengths of the diversity training already offered at MSM and combines resources from academia, the private sector, and the community at large.