bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using a Simulated Surgical Skills Station to Assess Laceration Management by Surgical and Nonsurgical Residents
Authors: Fargo Matthew V , Edwards John A , Roth Bernard J , Short Matthew W 
Published: July 2013

Abstract

Objective
To assess laceration management performance among surgical and nonsurgical postgraduate year-1 (PGY-1) residents objectively and to test for interval improvement.

Methods
From 2006 to 2008, 106 PGY-1 residents from 10 medical specialties were evaluated with a simulated surgical skills station using pigs' feet before and after internship. Subjects were given 11 minutes to choose the proper suture, prepare and close the wound, and answer laceration management questions. Trainees were classified as surgical (emergency medicine, general surgery, obstetrics and gynecology, orthopedics, and otolaryngology) and nonsurgical (family medicine, internal medicine, neurology, pediatrics, and transitional year). An objective checklist was used to assess performance.

Results
A total of 106 PGY-1 residents (age range, 25–44 years; mean, 28.7 years) participated, consisting of 41 surgical (39%) and 65 nonsurgical residents (61%). Surgical group scores improved from 78.4% to 87.7% (P &lt; .001). Nonsurgical scores improved from 67.2% to 73.1% (P &lt; .001). There was similar improvement between groups (surgical, 9.4%; nonsurgical, 5.9%; P  =  .21). Surgical residents outscored nonsurgical residents before (P &lt; .001) and after (P &lt; .001) internship.

Conclusion
Surgical residents outperformed nonsurgical residents before and after the PGY-1 year with similar score improvements. A simulated surgical skills station can be used to evaluate procedure performance objectively and to test for interval improvement. A simulated surgical skills station may serve as a useful adjunct to apprenticeship in assessing procedure competence.
Senior Pediatric Residents as Teachers for an Innovative Multidisciplinary Mock Code Curriculum
Authors: Sweeney Alison , Stephany Alyssa , Whicker Shari , Bookman Jack , Turner David A 
Published: July 2013

AbstractBackgroundResuscitation education for pediatric residents may be limited due to the low frequency of actual codes in children. Mock codes represent an opportunity to increase trainee education in acute resuscitations, and we designed a unique multidisciplinary mock code curriculum that uses senior pediatric residents as teachers.MethodsA novel mock code curriculum was designed and integrated into an existing night-float rotation. Our 2-tiered curriculum not only focuses on improving teaching proficiency for resident educators (REs) but also includes separate goals to augment simulation-based resuscitation education for resident participants (RPs) and the multidisciplinary staff.ResultsSeventy-six residents (17 REs, 59 RPs) and more than 75 nurses have participated in the curriculum. After participation, 100% of residents felt that this curriculum would improve the quality of actual resuscitations, and 94% of RPs reported receiving valuable feedback. Comfort with teaching and feedback increased for REs (P &lt; .05), and comfort in resuscitation and crisis resource management improved for RPs (P &lt; .05). The nursing staff also felt that communication, teamwork, and collaboration improved due to implementation of this curriculum.ConclusionsA unique mock code curriculum can improve resident comfort with teaching, peer facilitation, feedback, and resuscitation. Curricular interventions of this nature may also be able to improve the balance between service and education within a residency training program. As we move toward a competency based training model within graduate medical education, further investigation is needed to link educational modifications of this nature to clinical outcomes and actual resident performance.
A Collaborative Model for Inpatient Training in a Small Pediatric Residency Program
Authors: Carr Anna M , Irigoyen Matilde , Arbeter Allan M , Wimmer Robert S , McGregor Robert S , Reed Charles R , Schidlow Daniel V 
Published: July 2013

Abstract

Background
The nationwide decline in pediatric admissions to community hospitals threatens the sustainability of small pediatric residency programs. Little is known about the response of small programs to this challenge.

Objectives
We report on the design and evaluation of an innovative, collaborative model for pediatric inpatient training between an academic community medical center and a children's hospital.

Methods
We describe the operational, academic, and financial features of the model. Outcome measures include patient volume and subspecialty mix, resident and faculty perceptions as reported in an anonymous survey, and Accreditation Council for Graduate Medical Education Residency Review Committee (RRC) review.

Results
In 2003, Albert Einstein Medical Center (Einstein) closed its pediatric inpatient unit and established an independent teaching service at St Christopher's Hospital for Children (St Christopher's) in Philadelphia, Pennsylvania. Under the new model, patient volume and subspecialty mix more than tripled. Einstein residents and faculty identified 5 major strengths: level of responsibility and decision making, caring for medically complex children, quality of teaching, teamwork, and opportunity to participate in academic activities at a children's hospital. St Christopher's leadership reported increased volume, no disruption of their residency program, and no dilution of clinical teaching material. The Einstein program was reaccredited by the RRC in 2006 for 2 years and in 2009 for 4 years.

Conclusion
A collaborative model for inpatient training was successful in maintaining a community hospital–based pediatric residency program. Positive outcomes were documented for the residency program, the parent community hospital, and the collaborating children's hospital.
Enhancing Teamwork Between Chief Residents and Residency Program Directors: Description and Outcomes of an Experiential Workshop
Authors: McPhillips Heather A. , Frohna John G. , Murad M. Hassan , Batra Maneesh , Panda Mukta , Miller Marsha A. , Brigham Timothy P. , Doughty Robert A. 
Published: July 2013

Abstract

Background
An effective working relationship between chief residents and residency program directors is critical to a residency program's success. Despite the importance of this relationship, few studies have explored the characteristics of an effective program director-chief resident partnership or how to facilitate collaboration between the 2 roles, which collectively are important to program quality and resident satisfaction. We describe the development and impact of a novel workshop that paired program directors with their incoming chief residents to facilitate improved partnerships.

Methods
The Accreditation Council for Graduate Medical Education sponsored a full-day workshop for residency program directors and their incoming chief residents. Sessions focused on increased understanding of personality styles, using experiential learning, and open communication between chief residents and program directors, related to feedback and expectations of each other. Participants completed an anonymous survey immediately after the workshop and again 8 months later to assess its long-term impact.

Results
Participants found the workshop to be a valuable experience, with comments revealing common themes. Program directors and chief residents expect each other to act as a role model for the residents, be approachable and available, and to be transparent and fair in their decision-making processes; both groups wanted feedback on performance and clear expectations from each other for roles and responsibilities; and both groups identified the need to be innovative and supportive of changes in the program. Respondents to the follow-up survey reported that workshop participation improved their relationships with their co-chiefs and program directors.

Conclusion
Participation in this experiential workshop improved the working relationships between chief residents and program directors. The themes that were identified can be used to foster communication between incoming chief residents and residency directors and to develop a curriculum for chief resident development.
Comparative Reliability of Structured Versus Unstructured Interviews in the Admission Process of a Residency Program
Authors: Blouin Danielle , Day Andrew G. , Pavlov Andrey 
Published: July 2013

Abstract

Background
Although never directly compared, structured interviews are reported as being more reliable than unstructured interviews. This study compared the reliability of both types of interview when applied to a common pool of applicants for positions in an emergency medicine residency program.

Methods
In 2008, one structured interview was added to the two unstructured interviews traditionally used in our resident selection process. A formal job analysis using the critical incident technique guided the development of the structured interview tool. This tool consisted of 7 scenarios assessing 4 of the domains deemed essential for success as a resident in this program. The traditional interview tool assessed 5 general criteria. In addition to these criteria, the unstructured panel members were asked to rate each candidate on the same 4 essential domains rated by the structured panel members. All 3 panels interviewed all candidates. Main outcomes were the overall, interitem, and interrater reliabilities, the correlations between interview panels, and the dimensionality of each interview tool.

Results
Thirty candidates were interviewed. The overall reliability reached 0.43 for the structured interview, and 0.81 and 0.71 for the unstructured interviews. Analyses of the variance components showed a high interrater, low interitem reliability for the structured interview, and a high interrater, high interitem reliability for the unstructured interviews. The summary measures from the 2 unstructured interviews were significantly correlated, but neither was correlated with the structured interview. Only the structured interview was multidimensional.

Conclusions
A structured interview did not yield a higher overall reliability than both unstructured interviews. The lower reliability is explained by a lower interitem reliability, which in turn is due to the multidimensionality of the interview tool. Both unstructured panels consistently rated a single dimension, even when prompted to assess the 4 specific domains established as essential to succeed in this residency program.
Effects of Education on Interns' Verbal and Electronic Handoff Documentation Skills
Authors: Airan-Javia Subha L. , Kogan Jennifer R. , Smith Megan , Lapin Jennifer , Shea Judy A. , Dine C. Jessica , Ishida Koto , Myers Jennifer S. 
Published: July 2013

Abstract

Background
Improving handoff communications is a National Patient Safety Goal. Interns and residents are rarely taught how to safely handoff their patients. Our objective was to determine whether teaching safe handoff principles would improve handoff quality.

Methods
Our study was conducted on the inpatient services at 2 teaching hospitals. In this single-institution, randomized controlled trial, internal medicine interns (N  =  44) and residents (N  =  24) participated in a 45-minute educational session on safe handoff communication skills. Residents received additional education on effective feedback practices and were asked to provide each intern with structured feedback. Quality of interns' electronic and verbal handoffs was measured by using a Handoff Evaluation Tool created by the authors. The frequency of handoff communication failures was also assessed through semistructured phone interviews of postcall interns.

Results
Interns who received handoff education demonstrated superior verbal handoff skills than control interns (P &lt; .001), while no difference was seen in electronic handoff skills. Communication failures related to code status (P &lt; .001) and overnight tasks (P &lt; .050) were less frequent in the intervention group.

Conclusions
Interns' electronic handoff documentation skills did not improve with the intervention. This may reflect greater difficulty in changing physicians' electronic documentation habits.
Using a Commercially Available Web-Based Evaluation System to Enhance Residents' Teaching
Authors: Keller Jennifer M. , Blatt Benjamin , Plack Margaret , Gaba Nancy D. , Greenberg Larrie 
Published: July 2013

Abstract

Background
Residents-as-teachers (RATs) programs have been shown to improve trainees' teaching skills, yet these decline over time.

Intervention
We adapted a commercial Web-based system to maintain resident teaching skills through reflection and deliberate practice and assessed the system's ability to (1) prevent deterioration of resident teaching skills and (2) provide information to improve residents' teaching skills and teaching program quality.

Methods
Ten first-year obstetrics-gynecology (Ob-Gyn) residents participated in a RATs program. Following the program, they used a commercial evaluation system to complete self-assessments of their teaching encounters with medical students. Students also evaluated the residents. To assess the system's effectiveness, we compared these residents to historical controls with an Objective Structured Teaching Examination (OSTE) and analyzed the ratings and the free text comments of residents and students to explore teaching challenges and improve the RATs program.

Results
The intervention group outscored the control group on the OSTE (mean score ± SD  =  81 ± 8 versus 74 ± 7; P  =  .05, using a 2-tailed Student t-test). Rating scale analysis showed resident self-assessments were consistently lower than student evaluations, with the difference reaching statistical significance in 3 of 6 skills (P &lt; .05). Comments revealed that residents most valued using innovative teaching techniques, while students most valued a positive educational climate and interpersonal connections with residents. Recommended targets for RATs program improvement included teaching feedback, time-limited teaching, and modeling professionalism behaviors.

Conclusions
Our novel electronic Web-based reinforcement system shows promise in preventing deterioration of resident teaching skills learned during an Ob-Gyn RATs program. The system also was effective in gaining resident and student insights to improve RATs programs. Because our intervention was built upon a commercially available program, our approach could prove useful to the large population of current subscribers.
Narrative, Written Sign-Outs and Interns' and Senior Medical Students' Confidence: A Randomized, Controlled Crossover Trial
Authors: Chuang Elizabeth , Ark Tavinder K. , LoCurcio Michael 
Published: July 2013

Abstract

Background
Failures of communication during the transfer of patient care errors.

Methods
We created a new format for written sign-out material, based on aviation industry practice and cognitive psychology theory, designed to improve interns' and senior medical students' communication during transfers of patient care responsibility. We carried out a randomized, blinded, crossover trial, comparing a new, narrative, written sign-out report to a usual written sign-out. Thirty-two interns and fourth-year medical students rated their confidence across various clinical tasks and answered clinical questions regarding hypothetical patients presented to them in written, new, narrative sign-out compared with the customary format.

Results
There was no statistical difference in confidence when interns and senior medical students received usual versus narrative sign-outs.

Conclusions
Although a limited measure suggested some improvement in competence, the narrative format did not improve participants' self-rated confidence during patient-care transfer.
Developing Educators, Investigators, and Leaders During Internal Medicine Residency: The Area of Distinction Program
Authors: Kohlwes R. Jeffrey , Cornett Patricia , Dandu Madhavi , Julian Katherine , Vidyarthi Arpana , Minichiello Tracy , Shunk Rebecca , Jain Sharad , Harleman Elizabeth , Ranji Sumant , Sharpe Brad , O'Sullivan Patricia , Hollander Harry 
Published: July 2013

Abstract

Background
Professional organizations have called for individualized training approaches, as well as for opportunities for resident scholarship, to ensure that internal medicine residents have sufficient knowledge and experience to make informed career choices.

Context and Purpose
To address these training issues within the University of California, San Francisco, internal medicine program, we created the Areas of Distinction (AoD) program to supplement regular clinical duties with specialized curricula designed to engage residents in clinical research, global health, health equities, medical education, molecular medicine, or physician leadership. We describe our AoD program and present this initiative's evaluation data.

Methods and Program Evaluation
We evaluated features of our AoD program, including program enrollment, resident satisfaction, recruitment surveys, quantity of scholarly products, and the results of our resident's certifying examination scores. Finally, we described the costs of implementing and maintaining the AoDs.

Results
AoD enrollment increased from 81% to 98% during the past 5 years. Both quantitative and qualitative data demonstrated a positive effect on recruitment and improved resident satisfaction with the program, and the number and breadth of scholarly presentations have increased without an adverse effect on our board certification pass rate.

Conclusions
The AoD system led to favorable outcomes in the domains of resident recruitment, satisfaction, scholarship, and board performance. Our intervention showed that residents can successfully obtain clinical training while engaging in specialized education beyond the bounds of core medicine training. Nurturing these interests may empower residents to better shape their careers by providing earlier insight into internist roles that transcend classic internal medicine training.
Assessing the Impact of Innovative Training of Family Physicians for the Patient-Centered Medical Home
Authors: Carney Patricia A. , Eiff M. Patrice , Saultz John W. , Lindbloom Erik , Waller Elaine , Jones Samuel , Osborn Jamie , Green Larry 
Published: July 2013

Abstract

Background
New approaches to enhance access in primary care necessitate change in the model for residency education.

Purpose
To describe instrument design, development and testing, and data collection strategies for residency programs, continuity clinics, residents, and program graduates participating in the Preparing the Personal Physician for Practice (P4) project.

Methods
We developed and pilot-tested surveys to assess demographic characteristics of residents, clinical and operational features of the continuity clinics and educational programs, and attitudes about and implementation status of Patient Centered Medical Home (PCMH) characteristics. Surveys were administered annually to P4 residency programs since the project started in 2007. Descriptive statistics were used to profile data from the P4 baseline year.

Results
Most P4 residents were non-Hispanic white women (60.7%), married or partnered, attended medical school in the United States and were the first physicians in their families to attend medical school. Nearly 85% of residency continuity clinics were family health centers, and about 8% were federally qualified health centers. The most likely PCMH features in continuity clinics were having an electronic health record and having fully secure remote access available; both of which were found in more than 50% of continuity clinics. Approximately one-half of continuity clinics used the electronic health record for safety projects, and nearly 60% used it for quality-improvement projects.

Conclusions
We created a collaborative evaluation model in all 14 P4 residencies. Successful implementation of new surveys revealed important baseline features of residencies and residents that are pertinent to studying the effects of new training models for the PCMH.
The Relative Influence of Available Resources During the Residency Match: A National Survey of Canadian Medical Students
Authors: Blissett Sarah , Law Christine , Morra Dante , Ginsburg Shiphra 
Published: July 2013

Abstract

Background
Many medical students find choosing a residency challenging. There are several steps involved, including determining one's own priorities, arranging electives, choosing a training program and site, and preparing an in-depth application and a rank order list. Many resources are available to assist students, including the Canadian Resident Matching Service website, program websites, career counselors, career information sessions, mentors, peers, family/friends, and the Canadian Medical Residency Guide. Our study explored the relative impact of these resources on the career decision-making process.

Method
We invited medical students in their final year at 12 Canadian medical schools to complete an online survey. Questions included identifying the relative utility of resources in the context of each component of the decision-making process. Responses were analyzed using descriptive statistics.

Results
The response rate was 71% (1076 of 1518). Overall, mentors, family/friends, and peers had the most impact on students' decision making. Career counselors, websites, and the Canadian Medical Residency Guide had much less impact. Family/friends were most frequently cited as essential to the process; however, family/friends and peers were equal in having some impact.

Conclusions
Our findings suggest that students are most influenced by family, friends, and peers, who are not involved in the formal residency selection effort. Appreciating the impact of these influences on students' decision making is important to understanding how they decide on their future careers. The study supports continuation of mentorship programs. Future work could focus on qualitative research to further characterize resource use.
The Effect of the Hidden Curriculum on Resident Burnout and Cynicism
Authors: Billings Martha E. , Lazarus Michael E. , Wenrich Marjorie , Curtis J. Randall , Engelberg Ruth A. 
Published: July 2013

Abstract

Introduction
Residents learn and participate in care within hospital cultures that may tolerate unprofessional conduct and cynical attitudes, labeled the “hidden curriculum.” We hypothesized that this hidden curriculum may have deleterious effects on residents' professional development and investigated whether witnessing unprofessional behavior during residency was associated with burnout and cynicism.

Methods
We surveyed internal medicine residents at 2 academic centers for 3 years (2008–2010). Hidden curriculum items assessed exposure to unprofessional conduct. We used regression analyses to examine if hidden curriculum scores were associated with cynicism and the Maslach Burnout Inventory depersonalization and emotional exhaustion domain scores.

Results
The response rate was 48% (337 of 708). In the 284 surveys analyzed, 45% of respondents met burnout criteria and had significantly higher hidden curriculum scores (26 versus 19, P &lt; .001) than those not meeting criteria. In cross-sectional analyses, the hidden curriculum score was significantly associated with residents' depersonalization, emotional exhaustion, and cynicism scores. Cynicism scores were also associated with burnout.

Conclusions
Exposure to unprofessional conduct was associated with higher burnout and cynicism scores among internal medicine residents. We also found that cynicism and burnout were significantly associated and may be measures of similar but not necessarily identical responses to the challenges posed by residency. Measuring the hidden curriculum and cynicism may provide direction for educators attempting to reform hospital culture and improve resident well-being.