bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Multidisciplinary Approach for Teaching Systems-Based Practice to Internal Medicine Residents
Authors: Nabors Christopher , Peterson Stephen J , Weems Roger , Forman Leanne , Mumtaz Arif , Goldberg Randy , Kar Kausik , Borges Joseph A , Doctor Ida , Lubben Orpha , Pherwani Nisha , Frishman William H 
Published: July 2013

AbstractBackgroundRapid growth in the complexity of the health care environment (including monitoring systems for health care quality and patient safety) may result in graduating internists not being adequately prepared for the demands the system places on them. In response, the Residency Review Committee for Internal Medicine created the Educational Innovations Project (EIP) to encourage select residency training programs to develop new strategies and methods to meet changing demands in graduate medical education.MethodsAs part of the EIP, our program created an innovative administrative internship. This multiyear curriculum provides systems-based practice training and consists of a series of rotations that take place during the 3 years of internal medicine residency. Each session involves close interaction with the nonphysician personnel who are instrumental in making our institution a functional and cohesive unit. To assess the potential impact of the rotations, we survey senior residents, recent graduates, and faculty educators. In conjunction with the Performance and Patient Experience departments of the hospital, we track several systems-based practice metrics for residents, including compliance with core health care measures, length of stay, and patient satisfaction.ResultsResidents recognize the need to develop systems-based practice skills, to readily participate in structured curricula designed to enhance such skills, and to provide leadership in organizing and publishing quality improvement initiatives, and upon graduation, they may lament that they did not receive even more vigorous training in these areas.ConclusionAlthough internal medicine residencies continue to improve their training in systems-based practice, our experience suggests that an even greater emphasis on these skills may be warranted.
Smoking Cessation in Family Medicine: Effects of an Area Health Education Center Training Program
Authors: Johns Tracy L. , Lawrence Elizabeth , Martini Leila E. , Dunn Grace E. , Thompson Zachary J. , Zwygart Kira 
Published: July 2013

AbstractBackground and ObjectivesMany clinicians have not received adequate training in smoking cessation. We examined the effects of a tobacco training program on clinician behavior, attitudes, knowledge, and comfort related to smoking cessation.MethodsIn a prospective cohort study, family medicine residents and faculty completed a pretest, followed by an educational intervention that encompassed presentations on smoking cessation resources, motivational interviewing, and the neurobiology of addiction and pharmacotherapy. After 3 months, participants completed a postintervention survey. Results were analyzed using chi-square tests to examine the effects of training.ResultsThirty-three residents and faculty completed the pretraining survey and 25 completed the posttraining survey. Following training, participants were more familiar and comfortable with Public Health Service Clinical Practice Guidelines (P &lt; .0001). No significant differences were found in performance of the 5 As (Ask, Advise, Assess, Assist, and Arrange) or other behaviors, including providing assistance with counseling, cessation plans, resources, or pharmacotherapy. There were no improvements in knowledge of specific intervention plans or attitudes related to identifying and counseling smokers.ConclusionA multidisciplinary tobacco training program increases clinician familiarity and comfort with practice guidelines, and may contribute to improving care activities that promote a healthy lifestyle. Future research should explore other interventions that have the potential of changing practice patterns on a larger scale. Future studies should also assess the effect of training programs on patient-oriented outcomes.
Evaluating Professionalism, Practice-Based Learning and Improvement, and Systems-Based Practice: Utilization of a Compliance Form and Correlation with Conflict Styles
Authors: Ogunyemi Dotun , Eno Michelle , Rad Steve , Fong Alex , Alexander Carolyn , Azziz Ricardo 
Published: July 2013

Abstract

Objective
The purpose of this article was to develop and determine the utility of a compliance form in evaluating and teaching the Accreditation Council for Graduate Medical Education competencies of professionalism, practice-based learning and improvement, and systems-based practice.

Methods
In 2006, we introduced a 17-item compliance form in an obstetrics and gynecology residency program. The form prospectively monitored residents on attendance at required activities (5 items), accountability of required obligations (9 items), and completion of assigned projects (3 items). Scores were compared to faculty evaluations of residents, resident status as a contributor or a concerning resident, and to the residents' conflict styles, using the Thomas-Kilmann Conflict MODE Instrument.

Results
Our analysis of 18 residents for academic year 2007–2008 showed a mean (standard error of mean) of 577 (65.3) for postgraduate year (PGY)-1, 692 (42.4) for PGY-2, 535 (23.3) for PGY-3, and 651.6 (37.4) for PGY-4. Non-Hispanic white residents had significantly higher scores on compliance, faculty evaluations on interpersonal and communication skills, and competence in systems-based practice. Contributing residents had significantly higher scores on compliance compared with concerning residents. Senior residents had significantly higher accountability scores compared with junior residents, and junior residents had increased project completion scores. Attendance scores increased and accountability scores decreased significantly between the first and second 6 months of the academic year. There were positive correlations between compliance scores with competing and collaborating conflict styles, and significant negative correlations between compliance with avoiding and accommodating conflict styles.

Conclusions
Maintaining a compliance form allows residents and residency programs to focus on issues that affect performance and facilitate assessment of the ACGME competencies. Postgraduate year, behavior, and conflict styles appear to be associated with compliance. A lack of association with faculty evaluations suggests measurement of different perceptions of residents' behavior.
Initial Experiences in Embedding Core Competency Education in Entry-Level Surgery Residents Through a Nonclinical Rotation
Authors: Kahol Kanav , Huston Carrie , Hamann Jessica , Ferrara John J 
Published: July 2013

ABSTRACT

Background
Health care continues to expand in scope and in complexity. In this changing environment, residents are challenged with understanding its intricacies and the impact it will have on their professional activities and careers.

Aim
Embedding each of the competency elements in residents in a meaningful way remains a challenge for many surgery residency program directors.

Methods
We established a nonclinical rotation to provide surgery postgraduate year-1 (PGY-1) residents with a structured, multifaceted, largely self-directed curriculum into which each of the 6 core competencies are woven. Posttesting strategies were established for most curricular experiences to ensure to the greatest possible extent that each resident will have achieved an acceptable level of understanding of each of the competency areas before being given credit for the rotation.

Results
By uniformly exceeding satisfactory scores on respective objective analyses, residents demonstrated an increased (at least short-term) understanding of each of the assessed competency areas.

Conclusion
Our project sought to address a prior lack of opportunity for our residents to develop a sound foundation for our residents in systems-based practice. Our new rotation addresses systems-based practice in several different learning environments, including emergency medical service ride-along, sentinel event participation, and hospice visits. Several research projects have enhanced the overall learning program. Our experience shows that a rotation dedicated to competency training can provide an innovative and engaging means of teaching residents the value of each element.
Pilot Study Evaluating a Practice-Based Learning and Improvement Curriculum Focusing on the Development of System-Level Quality Improvement Skills
Authors: Tomolo Anne M , Lawrence Renée H , Watts Brook , Augustine Sarah , Aron David C , Singh Mamta K 
Published: July 2013

Abstract

Background
We developed a practice-based learning and improvement (PBLI) curriculum to address important gaps in components of content and experiential learning activities through didactics and participation in systems-level quality improvement projects that focus on making changes in health care processes.

Methods
We evaluated the impact of our curriculum on resident PBLI knowledge, self-efficacy, and application skills. A quasi-experimental design assessed the impact of a curriculum (PBLI quality improvement systems compared with non-PBLI) on internal medicine residents' learning during a 4-week ambulatory block. We measured application skills, self-efficacy, and knowledge by using the Systems Quality Improvement Training and Assessment Tool. Exit evaluations assessed time invested and experiences related to the team projects and suggestions for improving the curriculum.

Results
The 2 groups showed differences in change scores. Relative to the comparison group, residents in the PBLI curriculum demonstrated a significant increase in the belief about their ability to implement a continuous quality improvement project (P  =  .020), comfort level in developing data collection plans (P  =  .010), and total knowledge scores (P &lt; .001), after adjusting for prior PBLI experience. Participants in the PBLI curriculum also demonstrated significant improvement in providing a more complete aim statement for a proposed project after adjusting for prior PBLI experience (P  =  .001). Exit evaluations were completed by 96% of PBLI curriculum participants who reported high satisfaction with team performance.

Conclusion
Residents in our curriculum showed gains in areas fundamental for PBLI competency. The observed improvements were related to fundamental quality improvement knowledge, with limited gain in application skills. This suggests that while heading in the right direction, we need to conceptualize and structure PBLI training in a way that integrates it throughout the residency program and fosters the application of this knowledge and these skills.
Impact of a Teaching Rotation on Residents' Attitudes Toward Teaching: A 5-Year Study
Authors: Le-Bucklin Khanh-Van T. , Hicks Rebecca , Wong Aline 
Published: July 2013

Abstract

Background
Residents play a tremendous role in educating medical students and other residents during their training. Many residency programs have thus instituted formal instruction on teaching. This 5-year study was conducted to quantitatively evaluate the impact of a teaching rotation on residents' attitudes towards teaching.

Methods
Residents participated in a 1-month teaching rotation, which included didactic sessions as well as protected time to practice their teaching skills. Before and after the rotation, residents anonymously filled out surveys regarding their attitudes towards teaching. Data were collected from 73 residents from July 2004 to September 2009. The data were analyzed using a 2-tailed t-test with independent variables and a 1-way ANOVA followed by a posttest.

Results
Four categories showed significant improvement, including feeling prepared to teach (20% increase, P &lt; .0001), having confidence in their teaching ability (16% increase, P &lt; .0001), being aware of their expectations as a teacher (19% increase, P &lt; .0001), and feeling that their anxiety about teaching was at a healthy level (9% increase, P = .0112). There was an increase in the level of enthusiasm, but the P-value did not reach a significant range (P = .121). The level of enthusiasm started high and was significantly higher on the pretest than every other tested category (P &lt; .05).

Conclusions
Residents are enthusiastic about teaching, and their level of enthusiasm remains high following a teaching rotation. Residents feel more prepared to teach, more confident in their teaching ability, more aware of their expectations as a teacher, and less anxious about teaching following a formal teaching rotation.
Feasibility and Reliability of a Multisource Feedback Tool for Emergency Medicine Residents
Authors: Garra Gregory , Wackett Andrew , Thode Henry 
Published: July 2013

Abstract

Background
While the Accreditation Council for Graduate Medical Education recommends multisource feedback (MSF) of resident performance, there is no uniformly accepted MSF tool for emergency medicine (EM) trainees, and the process of obtaining MSF in EM residencies is untested.

Objective
To determine the feasibility of an MSF program and evaluate the intraclass and interclass correlation of a previously reported resident professionalism evaluation, the Humanism Scale (HS).

Methods
To assess 10 third-year EM residents, we distributed an anonymous 9-item modified HS (EM-HS) to emergency department nursing staff, faculty physicians, and patients. The evaluators rated resident performance on a 1 to 9 scale (needs improvement to outstanding). Residents were asked to complete a self-evaluation of performance, using the same scale.

Analysis
Generalizability coefficients (Eρ2) were used to assess the reliability within evaluator classes. The mean score for each of the 9 questions provided by each evaluator class was calculated for each resident. Correlation coefficients were used to evaluate correlation between rater classes for each question on the EM-HS. Eρ2 and correlation values greater than 0.70 were deemed acceptable.

Results
EM-HSs were obtained from 44 nurses and 12 faculty physicians. The residents had an average of 13 evaluations by emergency department patients. Reliability within faculty and nurses was acceptable, with Eρ2 of 0.79 and 0.83, respectively. Interclass reliability was good between faculty and nurses.

Conclusions
An MSF program for EM residents is feasible. Intraclass reliability was acceptable for faculty and nurses. However, reliable feedback from patients requires a larger number of patient evaluations.
Pediatric Resident-as-Teacher Curricula: A National Survey of Existing Programs and Future Needs
Authors: Fromme H. Barrett , Whicker Shari A. , Paik Steve , Konopasek Lyuba , Koestler Jennifer L. , Wood Beverly , Greenberg Larrie 
Published: July 2013

AbstractBackgroundWe conducted a national survey of US pediatric program directors to explore the current status, content, and teaching methods of Resident-as-Teacher (RAT) curricula. The purposes of the survey were to (1) determine the level and method of evaluation of such curricula, and (2) assess the need for a national curricular resource in this area.MethodsA survey was sent to US pediatric program directors that asked questions regarding demographics, support, design, development, content, and evaluation of RAT curricula, as well as existing needs and desires for RAT curricular resources.ResultsSixty-two percent of pediatric program directors completed our survey. Eighty-seven percent have a formal RAT curriculum, but more than 50% allocate 10 hours or less to it during residency. The primary teaching modalities are lectures and workshops. Content areas include feedback, in-patient teaching, communication skills, case-based teaching, role modeling, evaluation, leadership skills, 1-minute preceptors, teaching/learning styles, professionalism, and small-group teaching. Sixty-three percent of programs report evaluating their curricula, but only 27% perceive their program to be very/extremely effective. Nearly all respondents expressed interest in a national RAT curriculum, preferring web-based modules for dissemination.ConclusionsDespite an Accreditation Council for Graduate Medical Education requirement for a RAT curriculum, some pediatrics programs still lack one, and some consider their program only moderately effective. A wealth of curricular material exists across programs, which could be shared nationally. Establishing a national RAT curriculum would offer programs resources to meet educational mandates and the ability to tailor programs to best fit their own program needs.
Variability in Obtaining Institutional Review Board Approval for Quality Improvement Activities in Residency Programs
Authors: Conforti Lisa N. , Hess Brian J. , Ross Kathryn M. , Lynn Lorna A. , Holmboe Eric S. 
Published: July 2013

Abstract

Introduction
Quality improvement (QI) activities are an important part of residency training. National studies are needed to inform best practices in QI training and experience for residents. The impact of the Institutional Review Board (IRB) process on such studies is not well described.

Methods
This observational study looked at time, length, comfort level, and overall quality of experience for 42 residency training programs in obtaining approval or exemption for a nationally based educational QI study.

Results
For the 42 programs in the study, the time period to IRB approval/exemption was highly variable, ranging from less than 1 week to 56.5 weeks; mean and median time was approximately 18 weeks (SD, 10.8). Greater reported comfort with the IRB process was associated with less time to obtain approval (r  =  −.50; P &lt; .01; 95% CI, −0.70 to −0.23). A more positive overall quality of experience with the IRB process was also associated with less time to obtain IRB approval (r  =  −.60; P &lt; .01; 95% CI, −0.74 to −0.36).

Discussion
The IRB process for residency programs initiating QI studies shows considerable variance that is not explained by attributes of the projects. New strategies are needed to assist and expedite IRB processes for QI research in educational settings and reduce interinstitutional variability and increase comfort level among educators with the IRB process.
A Systematic Review of the Prevalence of Patient Assaults Against Residents
Authors: Kwok Stephanie , Ostermeyer Britta , Coverdale John 
Published: July 2013

Abstract

Objectives
The purpose of this study is to systematically review the literature on the prevalence of patient assaults against residents in all specialties, and to identify curricula that address this issue.

Methods
The authors searched published English-language literature using PubMed and Scopus databases using key terms including “patient,” “assaults,” “threats,” “violence,” “aggression,” and “residents.” A separate search to identify curricula used the same terms in combination with key words including “curriculum,” “didactics,” and “course.” Bibliographies of studies found by electronic searches were also searched manually.

Results
Fifteen studies met the inclusion criteria. Of these, 7 were conducted on psychiatry residents alone, 6 assessed assaults on residents in nonpsychiatric specialties, and 2 reported cross-specialty data. The prevalence of assaults was defined as the percentage of residents who have experienced at least one assault. The prevalence of physical assaults on residents was 38% in surgery, 26% in emergency medicine, 16% to 40% in internal medicine, 5% to 9% in pediatrics, and 25% to 64% in psychiatry. All studies were cross-sectional; none collected data prospectively. Definitions of assault were heterogeneous or not specified. Few of the assaults were reported to clinical supervisors or training directors, and no programs had a formal reporting process. Approximately 21% to 79% of psychiatry residents and 30% of residents in other specialties had received some training on how to manage violent patients. We found no descriptions of formal curricula for managing the possibility of patient violence against residents or for preparing for the aftermath.

Conclusions
Although the data are limited, assaults by patients are commonly experienced by residents in training. There is a paucity of information and curricula that pertain to reducing the prevalence of these incidents and to addressing potential psychologic consequences, especially in nonpsychiatric specialties.
The Impact of the Number of Admissions to the Inpatient Medical Teaching Team on Patient Safety Outcomes
Authors: Averbukh Yelena , Southern William 
Published: July 2013

Abstract

Introduction
The clinical work in academic internal medicine inpatient units is done by teaching teams. To date, few studies have investigated how team workload affects patient safety outcomes.

Objective
We examined the association between the number of patients seen by a teaching team, 30-day readmission, and 60-day mortality.

Methods
In this retrospective observational study we defined each team as “less busy” (total monthly admissions ≤49, the median for all teams) or “more busy” (total monthly admissions &gt;49). We compared patients in both groups' demographic characteristics, comorbidities (Charlson score), severity of illness (the Laboratory-based Acute Physiology Score [LAPS]), and length of stay using t tests, χ2 tests, and rank sum tests, as appropriate. Logistic regression models were constructed to determine whether there was an association between assignment to a busy team and readmission and mortality.

Results
Of 12 119 admissions examined, 6398 (52.8%) were assigned to the less busy teams and 5721 (47.2%) were assigned to busy teams. Mean length of stay was not statistically different between the groups (5.2 vs 5.3 days; P  =  .08). After adjustment for demographic and clinical characteristics (LAPS and Charlson score), care by a busy team was associated with greater 30-day readmission rate (odds ratio, 1.21; 95% confidence interval [CI], 1.10–1.34) but not with increased risk of mortality (odds ratio, 1.05; 95% CI, 0.88–1.27). There was a significant linear association between the number of monthly admissions to teams and the readmission rate.

Conclusions
Admission to a busier teaching team is associated with a 21% increase in the odds of 30-day readmission. Sixty-day mortality was not affected by the number of monthly admissions to the teaching team.