bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Neighborhood Health Exchange: Developing a Community Partnership in Residency
Authors: Tartaglia Kimberly M. , Press Valerie G. , Freed Benjamin H. , Baker Timothy , Tang Joyce W. , Cohen Julie C. , Laiteerapong Neda , Alvarez Kimberly , Schwartz Mindy , Arora Vineet M. 
Published: July 2013

Abstract

Background
The current system of residency training focuses on the hospital setting, and resident exposure to the surrounding community is often limited. However, community interaction can play an important role in ambulatory training and in learning systems-based practice, a residency core competency. The goal of the Neighborhood Health Exchange was to develop a community partnership to provide internal medicine residents with an opportunity to interface with community members through a mutually beneficial educational experience.

Methods
Internal medicine residents received training during their ambulatory block and participated in a voluntary field practicum designed to engage community members in discussions about their health. Community members participated in education sessions led by resident volunteers.

Results
Resident volunteers completed a survey on their experiences. All residents stated that the opportunity to lead an exchange was very useful to their overall residency training. Eight exchanges were held with a total of 61 community participants, who completed a 3-question survey following the session. This survey asked about the level of material, the helpfulness of the exchanges, and opportunities for improvement. We received 46 completed surveys from community members: 91% stated that the material was presented “at the right level” and 93% stated that the presentations were somewhat or very helpful. Eighty percent gave positive and encouraging comments about the exchange.

Conclusion
Effective community partnerships involve assessing needs of the stakeholders, anticipating leadership turnover, and adapting the Neighborhood Health Exchange model to different groups. Community outreach can also enhance internal medicine ambulatory training experience, provide residents with patient counseling opportunities, and offer a novel method to enhance resident understanding of systems-based practice, especially within the larger community in which their patients live.
Practice-Based Learning and Improvement for Institutions: A Case Report
Authors: Kirk Susan E. , Howell R. Edward 
Published: July 2013

Abstract

Background
In 2006, the University of Virginia became one of the first academic medical institutions to be placed on probation, after the Accreditation Council for Graduate Medical Education (ACGME) Institutional Review Committee implemented a new classification system for institutional reviews.

Intervention
After University of Virginia reviewed its practices and implemented needed changes, the institution was able to have probation removed and full accreditation restored. Whereas graduate medical education committees and designated institutional officials are required to conduct internal reviews of each ACGME–accredited program midway through its accreditation cycle, no similar requirement exists for institutions.

Learning
As we designed corrective measures at the University of Virginia, we realized that regularly scheduled audits of the entire institution would have prevented the accumulation of deficiencies. We suggest that institutional internal reviews be implemented to ensure that the ACGME institutional requirements for graduate medical education are met. This process represents practice-based learning and improvement at the institutional level and may prevent other institutions from receiving unfavorable accreditation decisions.
The Morbidity and Mortality Conference: A Unique Opportunity for Teaching Empathic Communication
Authors: Prose Neil S. , Brown Haywood , Murphy Gwendolyn , Nieves Angel 
Published: July 2013

Abstract

Background
The morbidity and mortality conference is an educational tradition in American medicine that dates to the early 20th century. Traditionally, this conference has focused entirely on issues of diagnosis and treatment, in the context of a disappointing clinical outcome.

Intervention
We report on a new method for teaching empathic doctor-patient communication skills at an obstetrics and gynecology morbidity and mortality conference. For each case presented, we identified the communications challenges and allowed faculty and residents to “practice” the discussion they would have with the patient and the patient's family in that situation. In some sessions, actors assumed the role of the patient. Following the discussion of the case, we offered didactic presentations on how we communicate with patients and their families. These focused on techniques for being patient centered and included the use of body language, open-ended questioning, reflective listening before offering to explain, and the importance of naming and validating emotions.

Results
The majority of participants felt the sessions to be helpful, and after one month many were able to identify a positive change in their interactions with patients.

Conclusions
We believe that this unique teaching format allows learners to refine their communication skills in the context of situations that they know to be both realistic and important.
Duty Hour Restrictions, Ambulatory Experience, and Surgical Procedural Volume in Obstetrics and Gynecology
Authors: Kane Sarah M. , Siddiqui Nazema Y. , Bailit Jennifer , Blanchard May Hsieh 
Published: July 2013

Abstract

Background
Prior studies of resident experience in gynecology looked only at the year before and after adoption of ACGME duty hour standards. This study sought to determine whether procedure volume differed after completion of a 4-year residency training program, before and after work hour reform.

Method
Inpatient and outpatient procedures performed by MetroHealth Medical Center/Cleveland Clinic program residents from 1998 to 2006 were obtained from Annual Reports of Institutional and Resident Experience. Four-year experience before and after duty hour restrictions were compared: hours worked were collected from resident schedules, ambulatory hours and procedures were compared directly, surgical procedures and deliveries were compared using a 2-tailed t test. Data were also obtained for institutional volume changes, and a corrected value, based on the rates of resident cases per available cases, was analyzed.

Results
Ambulatory hours worked per resident decreased after implementing work hour reform from 674 to 366 hours. The types of ambulatory and surgical procedures performed varied over time. Overall, basic surgical and obstetrical volume per resident did not change before and after work hour reform (mean before reform, 723 ± 117, mean after reform, 781 ± 200, P  =  .58 for gynecologic procedures; mean before reform, 611 ± 107, mean after reform, 535 ± 73, P  =  .18 for basic obstetrics and vaginal and cesarean deliveries). Institutional volume did not change significantly, although the percentage of the institutions' cases performed by residents did decrease for some procedures.

Conclusion
The ACGME duty hour restrictions do not limit the overall ambulatory or surgical procedural volume in an obstetrics and gynecology residency-training period.
Emotional Intelligence and the ACGME Competencies
Authors: Webb Anita R. , Young Richard A. , Baumer Joane G. 
Published: July 2013

Abstract

Background
Residency programs desire assessment tools for teaching and measuring resident attainment of the Accreditation Council for Graduate Medical Education competencies, including interpersonal and communication skills.

Objective
We sought to evaluate the use of emotional intelligence (EI) assessment and training tools in assessing and enhancing interpersonal and communication skills.

Methods
We used a quasi-experimental design, with an intervention and control group composed of 1 class each of family medicine residents. The intervention was EI coaching. The assessment used the Emotional and Social Competence Inventory, a 360-degree EI survey consisting of self and other (colleague) ratings for 12 EI competencies.

Results
There were 21 participants in each of the 3 assessments (test, posttest, and control). Our EI coaching intervention had very limited participation due to a lack of protected time for EI coaching and residents' competing obligations. Return rates for self surveys were 86% to 91% and 66% to 68% for others. On all 3 trials, ratings by others were significantly higher than self ratings for every competence (range, P &lt; .001–.045). None of the self ratings by the intervention group increased significantly for any of the competencies. None of the intervention group self ratings increased significantly on posttesting, whereas ratings by others increased significantly for coach/mentor (P &lt; .001). The teamwork rating decreased significantly on both self and other ratings (P &lt; .001). Achievement orientation was the highest intervention group posttest rating, and teamwork was the lowest.

Conclusions
EI is a necessary skill in today's health care environment, and our study found that a tool from another sector was useful in assessing resident EI skills. Because our EI coaching intervention was unsuccessful, the effects of coaching on interpersonal and communication skills could not be assessed.
Reflective Practice and Competencies in Global Health Training: Lesson for Serving Diverse Patient Populations
Authors: Castillo Jonathan , Goldenhar Linda M. , Baker Raymond C. , Kahn Robert S. , DeWitt Thomas G. 
Published: July 2013

Abstract

Background
Resident interest in global health care training is growing and has been shown to have a positive effect on participants' clinical skills and cultural competency. In addition, it is associated with career choices in primary care, public health, and in the service of underserved populations. The purpose of this study was to explore, through reflective practice, how participation in a formal global health training program influences pediatric residents' perspectives when caring for diverse patient populations.

Methods
Thirteen pediatric and combined-program residents enrolled in a year-long Global Health Scholars Program at Cincinnati Children's Hospital Medical Center during the 2007–2008 academic year. Educational interventions included a written curriculum, a lecture series, one-on-one mentoring sessions, an experience abroad, and reflective journaling assignments. The American Society for Tropical Medicine and Hygiene global health competencies were used as an a priori coding framework to qualitatively analyze the reflective journal entries of the residents.

Results
Four themes emerged from the coded journal passages from all 13 residents: (1) the burden of global disease, as a heightened awareness of the diseases that affect humans worldwide; (2) immigrant/underserved health, reflected in a desire to apply lessons learned abroad at home to provide more culturally effective care to immigrant patients in the United States; (3) parenting, or observed parental, longing to assure that their children receive health care; and (4) humanitarianism, expressed as the desire to volunteer in future humanitarian health efforts in the United States and abroad.

Conclusions
Our findings suggest that participating in a global health training program helped residents begin to acquire competence in the American Society for Tropical Medicine and Hygiene competency domains. Such training also may strengthen residents' acquisition of professional skills, including the Accreditation Council for Graduate Medical Education competencies.
Rubric Evaluation of Pediatric Emergency Medicine Fellows
Authors: Hsu Deborah C. , Macias Charles G. 
Published: July 2013

AbstractObjectivesTo develop and validate a rubric assessment instrument for use by pediatric emergency medicine (PEM) faculty to evaluate PEM fellows and for fellows to use to self-assess.MethodsThis is a prospective study at a PEM fellowship program. The assessment instrument was developed through a multistep process: (1) development of rubric format items, scaled on the modified Dreyfus model proficiency levels, corresponding to the 6 Accreditation Council for Graduate Medical Education core competencies; (2) determination of content and construct validity of the items through structured input and item refinement by subject matter experts and focus group review; (3) collection of data using a 61-item form; (4) evaluation of psychometrics; (5) selection of items for use in the final instrument.ResultsA total of 261 evaluations were collected from 2006 to 2007; exploratory factor analysis yielded 5 factors with Eigenvalues &gt;1.0; each contained ≥4 items, with factor loadings &gt;0.4 corresponding with the following competencies: (1) medical knowledge and practice-based learning and improvement, (2) patient care and systems-based practice, (3) interpersonal skills, (4) communication skills, and (5) professionalism. Cronbach α for the final 53-item instrument was 0.989. There was also significant responsiveness of the tool to the year of training.ConclusionA substantively and statistically validated rubric evaluation of PEM fellows is a reliable tool for formative and summative evaluation.
Feasibility of Implementing a Standardized Multisource Feedback Program in the Graduate Medical Education Environment
Authors: Richmond Margaret , Canavan Colleen , Holtman Matthew C , Katsufrakis Peter J 
Published: July 2013

Abstract

Background
Multisource feedback (MSF) is emerging as a central assessment method for several medical education competencies. Planning and resource requirements for a successful implementation can be significant. Our goal is to examine barriers and challenges to a successful multisite MSF implementation, and identify the benefits of MSF as perceived by participants.

Methods
We analyzed the 2007–2008 field trial implementation of the Assessment of Professional Behaviors, an MSF program of the National Board of Medical Examiners, conducted with 8 residency and fellowship programs at 4 institutions. We use a multimethod analysis that draws on quantitative process indicators and qualitative participant experience data. Process indicators include program attrition, completion of implementation milestones, number of participants at each site, number of MSF surveys assigned and completed, and adherence to an experimental rater training protocol. Qualitative data include communications with each program and semistructured interviews conducted with key field trial staff to elicit their experiences with implementation.

Results
Several implementation challenges are identified, including communication gaps and difficulty scheduling implementation and training workshops. Participant interviews indicate several program changes that should enhance feasibility, including increasing communication and streamlining the training process.

Conclusions
Multisource feedback is a complex educational intervention that has the potential to provide users with a better understanding of performance expectations in the graduate medical education environment. Standardization of the implementation processes and tools should reduce the burden on program administrators and participants. Further study is warranted to broaden our understanding of the resource requirements for a successful MSF implementation and to show how outcomes change as MSF gains broader acceptance.
Procedural Readiness of Pediatric Interns: Defining Novice Performance Through Simulation
Authors: Pruden Carla M. , Kerrey Benjamin T. , Mittiga Matthew , del Rey Javier Gonzalez 
Published: July 2013

AbstractBackgroundPediatric lumbar puncture (LP) is a common invasive procedure performed by physicians in training. The Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education recognize simulation as a tool for deliberate practice and standardized assessment of procedural performance.ObjectiveWe sought to perform a detailed review of simulated LP performance to elucidate reasons for pediatric residents' reported 26% failure rate.MethodsParticipants were enrolled in a single 30-minute session between July 2008 and January 2009. Data collected included former experience and training via questionnaire and video review of intern performance of a simulated LP on an infant model. Intern performance was assessed against a list of 10 procedural elements. Acquisition of cerebrospinal fluid (CSF), the number of elements performed on the first 2 attempts, and specific types of training/experience were analyzed for associations.ResultsAll 32 enrolled interns endorsed receiving some previous LP training. Training on a model was infrequent (38%). Interns reported performing a median of 2 LPs prior to enrollment (interquartile range, 2–4). Seven of 31 interns (22%) had yet to perform a live LP. Eleven of 32 interns (34%; 95% confidence interval [CI], 18%–51%) acquired CSF during the first 2 simulated attempts. No specific type of prior training or experience was statistically associated with either the number of procedural elements or successful CSF acquisition (all P &gt; .05). Interns performed a median of 7 of 10 procedural elements (interquartile range, 5.5–8). Early stylet removal was never performed. Complete removal of the stylet with all CSF checks was significantly associated with CSF acquisition (odds ratio, 9; 95% CI 0.98, 84.2). Avoidance of a spinous process upon skin entry was associated with a trend toward increased CSF acquisition (odds ratio, 3.5; 95% CI 0.76, 16.1).ConclusionDespite performing many common procedural elements, pediatric interns generally lack the ability to successfully acquire CSF during a simulated infant LP. Expert performance of an infant LP likely requires complete stylet removal with each check for CSF and early spinous process avoidance. A simulated infant LP allowed assessment of intern procedural performance as well as description of elements critical to successful CSF acquisition.
Morbidity and Mortality Conference in Obstetrics and Gynecology: A Tool for Addressing the 6 Core Competencies
Authors: Bevis Kerri S , Straughn J. Michael , Kendrick James E , Walsh-Covarrubias Julie , Kilgore Larry C 
Published: July 2013

Abstract

Background
Residency program directors are challenged to effectively teach and assess the Accreditation Council for Graduate Medical Education's (ACGME) 6 competencies. The purpose of this study was to characterize the morbidity and mortality (M&M) conference as a cost-effective and efficient approach for addressing the ACGME competencies through evaluation of resident participation and case diversity.

Methods
In our modified M&M conference, senior residents submit a weekly list of cases to the conference proctors. The resident presents the case, including a critique of management, using the medical literature. The resident submits a case summary evaluating patient care practices, integrating scientific evidence, and evaluating systemic barriers to care. Completed case summaries are distributed and archived for reference.

Results
During a 3-year period, 30 residents presented 196 cases. Of these, 37 (19%) directly related to systems-based practice, 20 (10%) involved problems with inadequate communication, and 11 (6%) included issues of professionalism or ethics. All cases involved practice-based learning and medical knowledge.

Conclusions
The M&M conference addresses the core competencies through resident participation as well as directed analysis of diverse cases.
Expanding Educators' Medical Curriculum Tool Chest: Minute Papers as an Underutilized Option for Obtaining Immediate Feedback
Authors: Singh Mamta K. , Lawrence Renée , Headrick Linda 
Published: July 2013

Abstract

Background
One barrier to systematically assessing feedback about the content or format of teaching conferences in graduate medical education is the time needed to collect and analyze feedback data. Minute papers, brief surveys designed to obtain feedback in a concise format, have the potential to fill this gap.

Objectives
To assess whether minute papers were a feasible tool for obtaining immediate feedback on resident conferences and to use minute papers, with one added question, to assess the usefulness of changing the format of resident morning report.

Methods
Minute papers were administered at the end of internal medicine morning report conferences before and after changing the traditional combined format (all residents) to a separate format (postgraduate year [PGY] 1 met separately from PGY-2 and PGY-3 trainees). We collected information during 3 months during 2 traditional sessions and 8 sessions in the format that separated PGY-1s (3 for PGY-1 and 5 for PGY-2 and PGY-3). Participants responded to an item rating the usefulness of the session and 3 open-ended questions.

Results
Trainees completed the forms in 2 to 3 minutes. Trainee assessment of the usefulness of internal medicine morning report appeared to increase after the change (4.09 versus 4.45 for PGY-1; 3.75 versus 4.38 for PGY-2 and PGY-3 residents).

Conclusions
Minute papers are practical instruments that provide manageable amounts of immediate feedback. In addition, minute papers can be adjusted slightly to help assess the impact of change. In that way, faculty can create an iterative process of feedback that models small cycles of change, a key quality improvement concept.
A Survey of Resident Opinions on Peer Evaluation in a Large Internal Medicine Residency Program
Authors: Dupras Denise M. , Edson Randall S. 
Published: July 2013

Abstract

Background
Starting in the 1960s, studies have suggested that peer evaluation could provide unique insights into the performance of residents in training. However, reports of resident resistance to peer evaluation because of confidentiality issues and the possible impact on their working relationships raised concerns about the acceptability and utility of peer evaluation in graduate medical education. The literature suggests that peers are able to reliably assess communication, interpersonal skills, and professionalism and provide input that may differ from faculty evaluations. This study assessed the attitudes of internal medicine residents 1 year after the implementation of a peer-evaluation system.

Methods
During the 2005–2006 academic year, we conducted an anonymous survey of the 168 residents in the Internal Medicine Residency Program at the Mayo Clinic, Rochester, Minnesota. Contingency table analysis was used to compare the response patterns of the groups.

Results
The response rate was 61% (103/168 residents) and it did not differ by year of training. Most residents (74/103; 72%) felt that peers could provide valuable feedback. Eighty percent of residents (82/103) felt the feedback was important for their professional development and 84% (86/102) agreed that peers observe behaviors not seen by attending faculty.

Conclusions
The results of this study suggest that internal medicine residents provide unique assessment of their peers and provide feedback they consider important for their professional development. More importantly, the results support the role of peer evaluation in the assessment of the competencies of professionalism and interpersonal and communication skills.