bluuebunny/crossref_metadata_2025_split huggingface dataset:
Field Trips as a Novel Means of Experiential Learning in Ambulatory Pediatrics
Authors: Friedland Allen R. , Rintel-Queller Hayley C. , Unnikrishnan Devi , Paul David A. 
Published: July 2013

AbstractBackgroundParents and caregivers look to pediatric health care providers for guidance on feeding, safety issues, and child-care products for children, but trainees have infrequent first-hand exposure to child products marketed to parents.ObjectiveTo conduct a pilot study to assess an experiential field trip as a novel method of enhancing medical knowledge in ambulatory pediatric feeding and safety.MethodsResident physicians and medical students visited a local children's store, where they took part in an interactive store tour, product discussions, and product demonstrations led by a physician educator. Participants also completed a 20-question pretest and a 20-question posttest related to common ambulatory pediatric feeding and safety issues, based on recent American Academy of Pediatrics (AAP) policy statements and practice guidelines.ResultsSixty-seven medical students and resident physicians participated in the study. Overall, participants' short-term knowledge significantly increased from 9.9 ± 2.6 to 15.4 ± 2.2 questions correct (P  =  .001), with statistically significant gains (P &lt; .001) on both the feeding and safety sections of the test. There were no differences in improvement based on participant's student or resident status, residency program type, program year, sex, or parental status. Ninety-five percent of the participants believed that their knowledge was enhanced by this approach, and participants uniformly agreed that this field trip was valuable to their pediatric training and that such field trip sessions should continue.ConclusionsThe inclusion of experiential learning through an interactive field trip in the curriculum of medical training was acceptable and feasible and showed short-term improvements in knowledge of AAP safety and feeding concepts.
A Novel Approach to Teaching Placement of a B-Lynch Suture: Description of Technique and Validation of Teaching Model
Authors: Vetere Patrick F. , Wayock Christopher P. , Muscat Jolene , Sicuranza Genevieve 
Published: July 2013

AbstractIntroductionPostpartum hemorrhage is a major cause of maternal morbidity and mortality throughout the world and uterine atony is the leading cause of postpartum hemorrhage. The B-Lynch brace suture is a fertility-sparing approach to treating intractable uterine atony at the time of cesarean delivery. However, many obstetricians lack confidence to perform this procedure, which they may not have performed during residency. In order to train all residents to perform the B-Lynch brace suture, we developed a realistic model by using a flank steak to imitate a gravid uterus.MethodsA convenience sample of obstetrics-gynecology faculty and residents at different levels of training at a single large hospital participated in this pilot project. Each physician reported self-perceived understanding of and confidence in performing the B-Lynch procedure before and immediately after practicing the technique using the flank-steak model, via a Likert-type survey (scale 1  =  low, 5  =  high). A Wilcoxon matched-pairs signed rank test was used to compare the before and after responses.ResultsThirty-four participants completed the flank-steak model training and pretraining/posttraining surveys. The median score (range) for self-perceived understanding was 4 (2–5) and increased to 5 (4–5) (P &lt; .01) after exposure to the training model. The confidence scores rose from 3 (1–5) to 5 (4–5) (P &lt; .01) after training.ConclusionThe flank-steak model for teaching the B-Lynch suture significantly improved resident and faculty self-perceived understanding of and confidence in performing this procedure, which is otherwise rarely practiced in residency.
Situation-Background-Assessment-Recommendation (SBAR) and Emergency Medicine Residents' Learning of Case Presentation Skills
Authors: Tews Matthew C. , Liu J. Marc , Treat Robert 
Published: July 2013

Abstract

Background
To date, no standardized presentation format is taught to emergency medicine (EM) residents during patient handoffs to consulting or admitting physicians. The Situation-Background-Assessment-Recommendation (SBAR) is a common format that provides a consistent framework to communicate pertinent information.

Objective
The objective of this study was to describe and evaluate the feasibility of using SBAR to teach interphysician communication skills to first-year EM residents to use during patient handoffs.

Methods
An educational study was designed as part of a pilot curriculum to teach first-year EM residents handoff communication skills. A standardized SBAR reporting format was taught during a 1-hour didactic intervention. All residents were evaluated using pretest/posttest simulated cases using a 17-item SBAR checklist initially, and then within 4 months to assess retention of the tool. A survey was distributed to determine resident perceptions of the training and potential clinical utility.

Results
There was a statistically significant improvement from the resident scores on the pretest/posttest of the first case (P  =  .001), but there was no difference between posttest of the first case and pretest of the second case (P  =  .34), suggesting retention of the material. There was a statistically significant improvement from the pretest and posttest scores on the second case (P  =  .001). The survey yielded good reliability for both sessions (Cronbach alpha  =  0.87 and 0.89, respectively), demonstrating statistically significant increases for the perceived quality of training, presentation comfort level, and the use of SBAR (P  =  .001).

Conclusion
SBAR was acceptable to first-year EM residents, with improvements in both the ability to apply SBAR to simulated case presentations and retention at a follow-up session. This format was feasible to use as a training method and was well received by our resident physicians. Future research will be useful in examining the general applicability of the SBAR model for interphysician communications in the clinical environment and residency training programs.
Use of a Structured Template to Facilitate Practice-Based Learning and Improvement Projects
Authors: McClain Elizabeth K. , Babbott Stewart F. , Tsue Terance T. , Girod Douglas A. , Clements Debora , Gilmer Lisa , Persons Diane , Unruh Greg 
Published: July 2013

Abstract

Background
The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to meet and demonstrate outcomes across 6 competencies. Measuring residents' competency in practice-based learning and improvement (PBLI) is particularly challenging.

Purpose
We developed an educational tool to meet ACGME requirements for PBLI. The PBLI template helped programs document quality improvement (QI) projects and supported increased scholarly activity surrounding PBLI learning.

Methods
We reviewed program requirements for 43 residency and fellowship programs and identified specific PBLI requirements for QI activities. We also examined ACGME Program Information Form responses on PBLI core competency questions surrounding QI projects for program sites visited in 2008–2009. Data were integrated by a multidisciplinary committee to develop a peer-protected PBLI template guiding programs through process, documentation, and evaluation of QI projects. All steps were reviewed and approved through our GME Committee structure.

Results
An electronic template, companion checklist, and evaluation form were developed using identified project characteristics to guide programs through the PBLI process and facilitate documentation and evaluation of the process. During a 24 month period, 27 programs have completed PBLI projects, and 15 have reviewed the template with their education committees, but have not initiated projects using the template.

Discussion
The development of the tool generated program leaders' support because the tool enhanced the ability to meet program-specific objectives. The peer-protected status of this document for confidentiality and from discovery has been beneficial for program usage. The document aggregates data on PBLI and QI initiatives, offers opportunities to increase scholarship in QI, and meets the ACGME goal of linking measures to outcomes important to meeting accreditation requirements at the program and institutional level.
Impact of Web-Based Review on Long-Term Retention of Simulation-Acquired Knee and Shoulder Aspiration and Injection Skills
Authors: Preisner Ruth , Jasti Harish , Elnicki Michael , Jeong Kwonho 
Published: July 2013

Abstract

Background
Musculoskeletal problems are the reason for one-quarter of primary care visits. Opportunities for internal medicine residents to perform joint aspirations and injections have declined. Simulation has been shown to improve procedure skills post completion of simulation courses, yet controversy exists about the durability of simulation-acquired skills.

Objective
To investigate whether web-based review preserves residents' joint procedure skills 6 to 30 months after a simulation course.

Methods
Postgraduate year–1 internal medicine residents participated in a simulation-based Joint Aspiration Injection Course consisting of web-based instructional material, guided practice on joint models, and a multiple-choice test. Procedure proficiency was scored by using a 3-component skills checklist. Six to 30 months later, residents who had participated in the simulation were randomly assigned to review or not to review the original web-based instructional material before retesting. The groups were compared by using Wilcoxon rank sum and matched pairs signed rank tests.

Results
Compared to the performance at the end of the simulation course, scores of all 3 procedure components declined (informed consent, 64.7–43.0 versus 30.6–23.8, P &lt; .001; procedure proficiency, 63.4–61.7 versus 46.4–44.3, P &lt; .001; and postprocedure instructions, 58.0–54.1 versus 29.9–29.4, P &lt; .001). However, the review group outperformed the nonreview group on informed consent (shoulder: 37.1 versus 24.6, P  =  .01) and postprocedure instructions (shoulder: 34.0 versus 25.2, P  =  .01; knee: 35.5 versus 24.8, P &lt; .001). Residents who reported doing actual procedures maintained a higher confidence level, compared with those reporting none (6.8–5.1 versus 4.1–3.6, P &lt; .001).

Conclusion
Shoulder and knee simulation-acquired skills declined 6 to 30 months after a simulation course. However, rereview of web-based instructional material improved proficiency in informed consent, shoulder, and postprocedure instructions, shoulder and knee.
An Assessment of Family Medicine Residency Networks in the United States
Authors: White Brett , Carney Patricia A. , Garvin Roger 
Published: July 2013

Abstract

Introduction
Residency networks, comprising groups of residency programs organized as collaborative ventures or consortia, have existed in the United States for more than 30 years. At the same time, there have been no comparative assessments of their structures and functions.

Objectives
We conducted a survey of residency networks to assess their organizational structures and activities.

Methods
We identified 9 residency networks and designed a survey to specifically assess their organizational structures and activities. This survey was sent electronically to network leadership and all respective program directors in each residency network. The survey contained 6 areas of focus: (1) network history and administration; (2) network funding; (3) resource sharing and communication within the network; (4) network activities; (5) research within the network; and (6) strengths and weaknesses of the network.

Results
Of the 9 networks, 5 provided data, with 32 of a possible 51 residency programs (62.8%) responding. Respondents reported predominantly functioning as affiliated networks (76.3%) rather than collaborative ventures or consortia. The networks have a variety of funding streams and share resources.

Conclusions
A major function of residency networks is the sharing of resources, particularly in the area of faculty development, with 97.1% of respondents sharing faculty development resources. In addition, all residency networks were actively involved in research, and they participated in political advocacy and in enhancing the engagement of medical students. Networks have been successful at obtaining grants to support their infrastructure.
Assessing the Utility of Procedural Training for Pediatrics Residents in General Pediatric Practice
Authors: Ben-Isaac Eyal , Keefer Matthew , Thompson Michelle , Wang Vincent J. 
Published: July 2013

AbstractBackgroundThe Accreditation Council for Graduate Medical Education (ACGME) recommends that residents gain broad procedural competence in pediatrics training. There is little recent information regarding practice patterns after graduation.ObjectiveWe analyzed reported procedures performed in actual practice by graduates of a general pediatrics residency program.MethodsWe conducted an online survey from April 2007 to April 2011 of graduates of a single pediatrics program from a large children's hospital. Eligible participants completed general pediatrics residency training between 1992 and 2006. Graduates were asked about the adequacy of their training for each procedure, as well as the frequency of commonly performed procedures in their practice. As the primary analysis, procedures were divided into emergent and urgent procedures.ResultsOur response rate was 54% (209 of 387). General pediatricians rarely performed emergent procedures, such as endotracheal intubation, intraosseous line placement, thoracostomy, and thoracentesis. Instead, they more commonly performed urgent procedures, such as laceration repair, fracture or dislocation care, bladder catheterization, foreign body removal, and incision and drainage of simple abscesses. Statistically significant differences existed between emergent and urgent procedures (P &lt; .001).ConclusionsIn a single, large, urban, pediatrics residency, 15 years of graduates who practiced general pediatrics after graduation reported they rarely performed emergent procedures, such as endotracheal intubation, but more often performed urgent procedures, such as laceration repair. These results may have implications for ACGME recommendations regarding the amount and type of procedural training required for general pediatrics residents.
Pilot Program Using Medical Simulation in Clinical Decision-Making Training for Internal Medicine Interns
Authors: Miloslavsky Eli M. , Hayden Emily M. , Currier Paul F. , Mathai Susan K. , Contreras-Valdes Fernando , Gordon James A. 
Published: July 2013

Abstract

Background
The use of high-fidelity medical simulation in cognitive skills training within internal medicine residency programs remains largely unexplored.

Objective
To design a pilot study to introduce clinical decision-making training using simulation into a large internal medicine residency program, explore the practicability of using junior and senior residents as facilitators, and examine the feasibility of using the program to improve interns' clinical skills.

Methods
Interns on outpatient rotations participated in a simulation curriculum on a voluntary basis. The curriculum consisted of 8 cases focusing on acute clinical scenarios encountered on the wards. One-hour sessions were offered twice monthly from August 2010 to February 2011. Internal medicine residents and simulation faculty served as facilitators.

Results
A total of 36 of 75 total interns volunteered to participate in the program, with 42% attending multiple sessions. Of all participants, 88% rated the sessions as “excellent,” 97% felt that the program improved their ability to function as an intern and generate a plan, and 81% reported improvement in differential diagnosis skills.

Conclusions
Simulation training was well received by the learners and improved self-reported clinical skills. Using residents as facilitators, supervised by faculty, was well received by the learners and enabled the implementation of the curriculum in a large training program. Simulation can provide opportunities for deliberate practice, and learners perceive this modality to be effective.
Self Versus External Assessment for Technical Tasks in Surgery: A Narrative Review
Authors: Zevin Boris 
Published: July 2013

Abstract

Background
Self-assessment is an intricate component of continuing professional development and lifelong learning for health professionals. The agreement between self and external assessment for cognitive tasks in health professionals is reported to be poor; however, this topic has not been reviewed for technical tasks in surgery.

Objective
To compare self and external assessment for technical tasks in surgery.

Methods
MEDLINE, ERIC, and Google Scholar databases were searched for data from January 1960 to November 2011. Inclusion criteria were restricted to articles published in English in peer-reviewed journals, which reported on a comparison between self and external assessment for a technical task in a surgical specialty and involved medical students, surgical residents, surgical fellows, or practicing surgeons. Abstracts of identified articles were reviewed and pertinent full-text versions were retrieved. Manual searching of bibliographies for additional studies was performed. Data were extracted in a systematic manner.

Results
From a total of 49 citations, 17 studies (35%) were selected for review. Eight of the 17 studies (47%) reported no agreement, whereas 9 studies (53%) reported an agreement between self and external assessment for technical tasks in surgery. Four studies (24%) reported higher self versus external assessment scores, whereas 3 studies (18%) reported lower self versus external assessment scores. Sixteen studies (94%) focused on retrospective self-assessment and 1 study (6%) focused on predictive self-assessment. Agreement improved with higher levels of participant training; with high-quality, timely, and relevant feedback; and with postprocedure video review.

Conclusions
This review demonstrated mixed results regarding an agreement between self and external assessment scores for technical tasks in surgery. Future investigations should attempt to improve the study design by accounting for differences between men and women, conducting paired and independent mean comparisons of self and external assessments, and ensuring that external assessments are valid and reliable.
A Citation Tracking System to Facilitate Sponsoring Institution Oversight of ACGME-Accredited Programs
Authors: Long Timothy R. , Poe John D. , Zimmerman Richard S. , Rose Steven H. 
Published: July 2013

Abstract

Background
The Accreditation Council for Graduate Medical Education (ACGME) requires the graduate medical education committee and the designated institutional official to ensure that citations for noncompliance with the accreditation standards and institutional trends in citations are reviewed and corrected.

Objective
To describe a citation tracking system (CTS) that uses Microsoft Office Access to efficiently catalogue, monitor, and document resolution of citations.

Innovation
The CTS was implemented in a sponsoring institution with oversight of 133 ACGME-accredited programs. The designated institutional official and the graduate medical education committee review all program letters of notification and enter citations into the CTS. A program-correction plan is required for each citation and is entered into the database. Open citations and action plans are reviewed by the graduate medical education committee and the designated institutional official on a quarterly basis, with decisions ranging from “closing” the citation to approving the action plan in process to requiring a new or modified action plan. Citation categories and subcategories are accessed on the ACGME website and entered into the CTS to identify trends.

Results
All 236 citations received since the 2006 Mayo School of Graduate Medical Education institutional site visit were entered into the CTS. On November 22, 2011, 26 of 236 citations (11%) were in active status with ongoing action plans, and 210 (89%) citations had been resolved and were closed.

Conclusions
The CTS uses commercially available software to ensure citations are monitored and addressed and to simplify analysis of citation trends. The approach requires minimal staff time for data input and updates and can be performed without institutional information technology assistance.
Evaluating Nonphysician Staff Members' Self-Perceived Ability to Provide Multisource Evaluations of Residents
Authors: Nikels Susan Michelle , Guiton Gretchen , Loeb Danielle , Brandenburg Suzanne 
Published: July 2013

AbstractBackgroundMultisource evaluations of residents offer valuable feedback, yet there is little evidence on the best way to collect these data from a range of health care professionals.ObjectiveThis study evaluated nonphysician staff members' ability to assess internal medicine residents' performance and behavior, and explored whether staff members differed in their perceived ability to participate in resident evaluations.MethodsWe distributed an anonymous survey to nurses, medical assistants, and administrative staff at 6 internal medicine residency continuity clinics. Differences between nurses and other staff members' perceived ability to evaluate resident behavior were examined using independent t tests.ResultsThe survey response rate was 82% (61 of 74). A total of 55 respondents (90%) reported that it was important for them to evaluate residents. Participants reported being able to evaluate professional behaviors very well (62% [36 of 58] on the domain of respect to staff; 61% [36 of 59] on attire; and 54% [32 of 59] on communication). Individuals without a clinical background reported being uncomfortable evaluating medical knowledge (60%; 24 of 40) and judgment (55%; 22 of 40), whereas nurses reported being more comfortable evaluating these competencies. Respondents reported that the biggest barrier to evaluation was limited contact (86%; 48 of 56), and a significant amount of feedback was given verbally rather than on written evaluations.ConclusionsNonphysician staff members agree it is important to evaluate residents, and they are most comfortable providing feedback on professional behaviors. A significant amount of feedback is provided verbally but not necessarily captured in a formal written evaluation process.