bluuebunny/crossref_metadata_2025_split huggingface dataset:
County Jail as a Novel Site for Obstetrics and Gynecology Resident Education
Authors: Sufrin Carolyn B. , Autry Amy M. , Harris Kathryn L. , Goldenson Joe , Steinauer Jody E. 
Published: July 2013

Abstract

Introduction
Obstetrics and gynecology residents benefit from providing care to diverse patient populations and increasing their awareness of the social determinants of health.

Objectives
To describe and evaluate an outpatient rotation for obstetrics and gynecology residents at a county jail.

Methods
A comprehensive curriculum incorporating Accreditation Council for Graduate Medical Education (ACGME) core competencies was designed for all first-year residents to rotate weekly at the local county jail during their 6-week ambulatory care block. Residents completed an anonymous online evaluation and wrote a reflective essay at the end of the rotation. Data for patient visits were tabulated.

Results
All 9 first-year residents completed the rotation and the evaluation. Seventy-eight percent of patient visits were for gynecologic services, predominantly family planning. Residents reported that the rotation overall was a positive experience, emphasizing the unique intersection between psychosocial issues and health care in the jail setting. Rotation objectives that satisfied the 6 ACGME competencies were met.

Discussion
Providing care to incarcerated women through a structured curriculum is a novel way to encourage obstetrics and gynecology residents to consider the social determinants of health and for residents to cultivate their counseling skills. The rotation also included a wide breadth and depth of clinical diagnoses and procedures. Obstetrics and gynecology residency programs should consider a curriculum in reproductive health for incarcerated women.
Global Health Fellowships: A National, Cross-Disciplinary Survey of US Training Opportunities
Authors: Nelson Brett D. , Izadnegahdar Rasa , Hall Lauren , Lee Patrick T. 
Published: July 2013

Abstract

Introduction
Medical trainee interest and participation in global health programs have been growing at unprecedented rates, and the response has been increasing opportunities for medical students and residents. However, at the fellowship level, the number and types of global health training opportunities across specialties have not previously been characterized.

Methods
A cross-sectional survey was conducted between November and December 2010 among all identified global health fellowship programs in the United States. Programs were identified through review of academic and institutional websites, peer-reviewed literature, web-based search engines, and epidemiologic snowball sampling. Identified global health fellowship programs were invited through e-mail invitation and follow-up telephone calls to participate in the web-based survey questionnaire.

Results
The survey identified 80 global health fellowship programs: 31 in emergency medicine, 14 in family medicine, 11 in internal medicine, 10 in pediatrics, 8 interdisciplinary programs, 3 in surgery, and 3 in women's health. Of these, 46 of the programs (57.5%) responded to the survey. Fellowship programs were most commonly between 19 and 24 months in duration and were nearly equally divided among 2 models: (1) fellowship integrated into residency, and (2) fellowship following completion of residency. Respondents also provided information on selection criteria for fellows, fellowship training activities, and graduates' career choices. Nearly half of fellowship programs surveyed were recently established and had not graduated fellows at the time of the study.

Conclusion
Institutions across the nation have established a significant, diverse collection of global health fellowship opportunities. A public online database (www.globalhealthfellowships.org), developed from the results of this study, will serve as an ongoing resource on global health fellowships and best practices.
High-Fidelity Simulation as an Experiential Model for Teaching Root Cause Analysis
Authors: Quraishi Sadeq A. , Kimatian Stephen J. , Murray W. Bosseau , Sinz Elizabeth H. 
Published: July 2013

Abstract

Purpose
The purpose of this study was to assess the effectiveness of high-fidelity simulation for teaching root cause analysis (RCA) in graduate medical education.

Methods
Thirty clinical anesthesiology-1 through clinical anesthesiology-3 residents were randomly assigned to 2 groups: group A participants received a 10-minute lecture on RCA and participated in a simulation exercise where a medical error occurs, and group B participants received the 10-minute lecture on RCA only. Participants completed baseline, postintervention, and 6-month follow-up assessments, and they were evaluated on their attitude toward as well as understanding of RCA and “systems-based” care.

Results
All 30 residents completed the surveys. Baseline attitudes and knowledge scores were similar between groups. Postintervention knowledge scores were also similar between groups; however, group B was significantly more skeptical (P &lt; .001) about the use of RCA and “systems improvement” strategies. Six months later, group A demonstrated retained knowledge scores and unchanged attitude, whereas group B demonstrated significantly worse knowledge scores (P  =  .001) as well as continued skepticism toward a systems-based approach (P &lt; .001) to medical error reduction.

Conclusion
High-fidelity simulation in conjunction with focused didactics is an effective strategy for teaching RCA and systems theory in graduate medical education. Our findings also suggest that there is greater retention of knowledge and increased positive attitude toward systems improvement when focused didactics are coupled with a high-fidelity simulation exercise.
The Effect of a Patient- and Family-Centered Care Curriculum on Pediatrics Residents' Patient-Centeredness
Authors: Mann Keith J. , Hoffman Amber , Miller DeeJo , Chadwick Sheryl , Bratcher Denise 
Published: July 2013

Abstract

Background
Patient- and family-centered care (PFCC) approaches to care are important in enhancing the patient-centeredness of the health care experience, yet little is known about the effectiveness of formal approaches for teaching patient-centeredness in residency.

Intervention
We developed and implemented a PFCC curriculum and assessed its impact on residents' self-perceptions of patient-centered behavior and practices.

Methods
We used a quasi-experimental, nonrandomized approach with a pretest-posttest design. An experimental group of 24 interns filled out the Patient Practitioner Orientation Scale (PPOS) before residency, and a control group of 18 graduating residents who had not been exposed to a PFCC curriculum also completed the PPOS. After 2 years of residency and exposure to a PFCC curriculum, interns in the experimental group repeated the PPOS. We compared mean total and subscale PPOS scores.

Results
There was no difference in baseline total or subscale PPOS scores between the experimental and control group. The mean total PPOS score for the experimental group after exposure to the curriculum was 4.55 (P  =  .45), reflecting no change in patient-centeredness. The 17 female interns in the intervention group were more patient centered (4.8 ± 0.36) than the 6 male interns (4.2 ± 0.38) (P  =  .005), scoring significantly higher (4.6 ± 0.39 versus 4.0 ± 0.38) in the sharing domain (P  =  .001).

Conclusion
Interns' exposure to a PFCC curriculum did not result in a change in their perceived patient-centeredness. Most pediatrics residents at our children's hospital perceive themselves as patient and family centered at the start of residency and remain so throughout.
Use of Ecological Momentary Assessment to Determine Which Structural Factors Impact Perceived Teaching Quality of Attending Rounds
Authors: Willett Lisa , Houston Thomas K. , Heudebert Gustavo R. , Estrada Carlos 
Published: July 2013

Abstract

Introduction
Providing high-quality teaching to residents during attending rounds is challenging. Reasons include structural factors that affect rounds, which are beyond the attending's teaching style and control.

Objective
To develop a new evaluation tool to identify the structural components of ward rounds that most affect teaching quality in an internal medicine (IM) residency program.

Methods
The authors developed a 10-item Ecological Momentary Assessment (EMA) tool and collected daily evaluations for 18 months from IM residents rotating on inpatient services. Residents ranked the quality of teaching on rounds that day, and questions related to their service (general medicine, medical intensive care unit, and subspecialty services), patient census, absenteeism of team members, call status, and number of teaching methods used by the attending.

Results
Residents completed 488 evaluation cards over 18 months. This found no association between perceived teaching quality and training level, team absenteeism, and call status. We observed differences by service (P &lt; .001) and patient census (P  =  .009). After adjusting for type of service, census was no longer significant. Use of a larger variety of teaching methods was associated with higher perceived teaching quality, regardless of service or census (P for trend &lt; .001).

Conclusions
The EMA tool successfully identified that higher patient census was associated with lower perceived teaching quality, but the results were also influenced by the type of teaching service. We found that, regardless of census or teaching service, attendings can improve their teaching by diversifying the number of methods used in daily rounds.
Experience-Based Guidance for Implementing a Direct Observation Checklist in a Pediatric Emergency Department Setting
Authors: FitzGerald Michael , Mallory Mia , Mittiga Matthew , Schubert Charles , Schwartz Hamilton , Gonzalez Javier , Duma Elena , McAneney Constance 
Published: July 2013

Abstract

Background
The importance and benefits of direct observation in residency training have been underscored by a number of studies. Yet, implementing direct observation in an effective and sustainable way is hampered by demands on physicians' time and shrinking resources for educational innovation.

Objective
To describe the development and pilot implementation of a direct observation tool to assess the history and physical examination skills of interns in a pediatric emergency department rotation.

Methods
A task force developed specific history and physical examination checklists for a range of common conditions. For the pilot implementation, 10 pediatric emergency medicine faculty attendings conducted the initial observations of 34 interns during the course of 1 academic year. At the conclusion of the pilot, the faculty observers and interns were interviewed to assess the feasibility and benefits of the process.

Results
A total of 33 of the 34 interns were observed during their rotation, with 26 of the observations conducted when the faculty observer was off shift, and it took approximately 20 minutes to complete each observation. In terms of learning benefits, interns and faculty observers reported that it facilitated clear and useful feedback and revealed gaps that would not have otherwise been identified. Faculty observers also mentioned that it helped them focus their teaching effort, built empathy with learners, and gave them a way to demonstrate a true concern for their learning.

Conclusion
Our results offer evidence for the feasibility and benefits of the direct observation checklists. The description of the implementation, challenges, and response to those challenges may help others avoid some of the common problems faced when implementing direct observation methods.
Medical Students' Perception of Residents as Teachers: Comparing Effectiveness of Residents and Faculty During Simulation Debriefings
Authors: Cooper Dylan D. , Wilson Adam B. , Huffman Gretchen N. , Humbert Aloysius J. 
Published: July 2013

Abstract

Background
Simulation can enhance undergraduate medical education. However, the number of faculty facilitators needed for observation and debriefing can limit its use with medical students. The goal of this study was to compare the effectiveness of emergency medicine (EM) residents with that of EM faculty in facilitating postcase debriefings.

Methods
The EM clerkship at Indiana University School of Medicine requires medical students to complete one 2-hour mannequin-based simulation session. Groups of 5 to 6 students participated in 3 different simulation cases immediately followed by debriefings. Debriefings were led by either an EM faculty volunteer or EM resident volunteer. The Debriefing Assessment for Simulation in Healthcare (DASH) participant form was completed by students to evaluate each individual providing the debriefing.

Results
In total, 273 DASH forms were completed (132 EM faculty evaluations and 141 EM resident evaluations) for 7 faculty members and 9 residents providing the debriefing sessions. The mean total faculty DASH score was 32.42 and mean total resident DASH score was 32.09 out of a possible 35. There were no statistically significant differences between faculty and resident scores overall (P  =  .36) or by case type (Ptrauma  =  .11, Pmedical  =  .19, Ppediatrics  =  .48).

Conclusions
EM residents were perceived to be as effective as EM faculty in debriefing medical students in a mannequin-based simulation experience. The use of residents to observe and debrief students may allow additional simulations to be incorporated into undergraduate curricula and provide valuable teaching opportunities for residents.
Development of a Test of Residents' Ethics Knowledge for Pediatrics (TREK-P)
Authors: Kesselheim Jennifer C. , McMahon Graham T. , Joffe Steven 
Published: July 2013

AbstractBackgroundProfessionalism is one of the Accreditation Council for Graduate Medical Education's core competencies. Residency programs must teach residents about ethical principles, which is an essential component of professionalism.ObjectivesWe aimed to formally develop a valid and reliable test of ethics knowledge that effectively discriminated among learners in pediatric residency training and to improve methods for measuring outcomes of resident education in medical ethics.MethodsWe created an instrument with 36 true/false questions that tested knowledge in several domains of pediatric ethics: professionalism, adolescent medicine, genetic testing and diagnosis, neonatology, end-of-life decisions, and decision making for minors. All questions and their correct answers were derived from published statements from the American Academy of Pediatrics Committee on Bioethics. We invited a range of participants from novices to experts to complete the test. We evaluated the instrument's reliability and explored item discrimination, omitting 13 items with the least discriminatory power. Score differences between the 3 categories of examinees were evaluated.ResultsThe 23-item test, completed by 54 participants, demonstrated good internal reliability (Kuder-Richardson 20 statistic  =  0.73). The test was moderately difficult and had a mean overall score of 17.3 (±3.3 standard deviation). Performance appropriately improved with degree of expertise: median scores for medical students, postgraduate year-3 residents, and ethicists were 15 (65%, range, 11–19), 19 (83%, range, 14–23), and 22 (96%, range, 20–23), respectively. Ethicists' scores were significantly higher than those of medical students (P &lt; .001) and residents (P  =  .007). Moreover, residents performed significantly better than medical students (P  =  .001).ConclusionsWe developed a standardized instrument, entitled Test of Residents' Ethics Knowledge for Pediatrics (TREK-P), to evaluate residents' knowledge of pediatric ethics. The TREK-P is easy to administer, reliably discriminates among learners, and highlights content areas in which knowledge may be deficient.
Education and Training of Referring Physicians Decreases At-Home Call Demand
Authors: Nemani Abhishek K. , Grant William D. , Noël Léon-Paul 
Published: July 2013

Abstract

Background
Excessive, sometimes unnecessary consultation challenges the ophthalmology resident's ability to obtain adequate rest and personal time while taking at-home calls. Basic training of nonophthalmologists in assessing and treating common ophthalmic emergencies offers a potential solution to this problem by providing primary caregivers the knowledge base, tools, and confidence to manage them independently.

Objective
We measured ophthalmic consultation requests at a large teaching institution and the impact of an educational intervention on the number and type of requests.

Methods
During a 31-day period in 2009 all requests for urgent ophthalmic consultation were logged and characterized by reason, urgency, and source of the call. A 3-part educational intervention was targeted to residents and attending physicians in the departments of emergency medicine (half-day lecture and practice), anesthesiology (grand rounds lecture), and otolaryngology (guidelines for traumatic orbital fractures). Six months later we conducted a 26-day call log to evaluate the impact.

Results
Pre intervention, we received 63 total and 56 after-hours calls for urgent ophthalmic consultation as compared to 39 total and 35 after-hours calls post intervention. Ophthalmology residents reported seeing more urgent and fewer nonessential consultations in the postintervention period, and there was greater agreement between calling physicians' initial diagnosis and consulting physicians' final diagnosis. No adverse patient outcomes occurred as a result of the change in practices.

Conclusion
Basic education of nonophthalmologists in ophthalmic diagnostic and treatment concepts, through relatively brief educational interventions, was associated with a decrease in total consultation requests and more appropriate consultations in this pilot study at a single institution.
Self-Assessment on the Competencies and Reported Improvement Priorities for Pediatrics Residents
Authors: Li Su-Ting T. , Tancredi Daniel J. , Burke Ann E. , Guillot Ann , Guralnick Susan , Trimm R. Franklin , Mahan John D. 
Published: July 2013

Abstract

Background
Self-assessment and self-directed learning are essential to becoming an effective physician.

Objective
To identify factors associated with resident self-assessment on the competencies, and to determine whether residents chose areas of self-assessed relative weakness as areas for improvement in their Individualized Learning Plan (ILP).

Methods
We performed a cross-sectional analysis of the American Academy of Pediatrics' PediaLink ILP database. Pediatrics residents self-assessed their competency in the 6 Accreditation Council for Graduate Medical Education competencies using a color-coded slider scale with end anchors “novice” and “proficient” (0–100), and then chose at least 1 competency to improve. Multivariate regression explored the relationship between overall confidence in core competencies, sex, level of training, and degree (MD or DO) status. Correlation examined whether residents chose to improve competencies in which they rated themselves as lower.

Results
A total of 4167 residents completed an ILP in academic year 2009–2010, with residents' ratings improving from advanced beginner (48 on a 0–100 scale) in postgraduate year-1 residents (PGY-1s) to competent (75) in PGY-3s. Residents rated themselves as most competent in professionalism (mean, 75.3) and least competent in medical knowledge (mean, 55.8) and systems-based practice (mean, 55.2). In the adjusted regression model, residents' competency ratings increased by level of training and whether they were men. In PGY-3s, there was no difference between men and women. Residents selected areas for improvement that correlated to competencies where they had rated themselves lower (P &lt; .01).

Conclusion
Residents' self-assessment of their competencies increased by level of training, although residents rated themselves as least competent in medical knowledge and systems-based practice, even as PGY-3s. Residents tended to choose subcompetencies, which they rated as lower to focus on improving.
Effect of Procedure Simulation Workshops on Resident Procedural Confidence and Competence
Authors: Augustine Erin M. , Kahana Madelyn 
Published: July 2013

Abstract

Background
Pediatrics residents perform a limited number of some procedures in the clinical setting and may benefit from procedure simulation workshops.

Objective
To examine (1) the number and types of procedures performed by pediatrics residents in the clinical setting, (2) the relationship between the number of procedures performed and self-reported procedural confidence and competence, and (3) the effect of a procedure simulation workshop on self-reported procedural confidence and competence.

Methods
Pediatrics residents at Lucile Packard Children's Hospital at Stanford attended a half-day procedure workshop, rotating between 6 procedure simulation stations: vascular access, airway management, bladder catheterization, chest tube placement, lumbar puncture, and umbilical lines. Residents completed a survey immediately before and after the workshop to self-assess procedural confidence and competence.

Results
Seventy-two residents participated in a procedure workshop. The average number of procedures performed increased significantly from intern to junior to senior year. A positive correlation was found between number of procedures performed and preworkshop confidence (P &lt; .001, R2  =  0.86) and competence (P &lt; .001, R2  =  0.88). For each procedure assessed, completion of the procedure simulation workshop resulted in a statistically significant (P &lt; .001) increase in self-perceived confidence (14%–131%; average, 48%) and competence (12%–119%; average, 50%). Statistically significant (P &lt; .05) increases remained when results for interns, juniors, and seniors were examined separately.

Conclusion
Procedure simulation workshops improve resident self-reported procedural confidence and competence, particularly for procedures that are least performed.
Internal Medicine Residents' Computer Use in the Inpatient Setting
Authors: Oxentenko Amy S. , Manohar Chinmay U. , McCoy Christopher P. , Bighorse William K. , McDonald Furman S. , Kolars Joseph C. , Levine James A. 
Published: July 2013

Abstract

Background
Studies have suggested that patient contact time for internal medicine residents is decreasing and being replaced with computer-related activities, yet objective data regarding computer use by residents are lacking.

Objective
The aim of this study was to objectively measure time use by internal medicine residents while on duty in the hospital setting using real-time, voice-capture technology.

Methods
First- and third-year categoric internal medicine residents participated (n  =  25) during a 3-month period in 2010 while rotating on general internal medicine rotations. Portable speech-recognition technology was used to record residents' activities. The residents were prompted every 15 minutes from an earpiece and asked to categorize the activity they had been doing since the last prompt, choosing from a predetermined list of 15 activities.

Results
Of the 1008 duty-time responses, 493 (49%) were classified as computer-related activities, whereas 341 (34%) were classified as direct patient care, 110 (11%) were classified as noncomputer-related education, and 64 (6%) were classified as other activities. Of resident reported computer-use time, 70% was spent on patient notes and order entry.

Conclusions
The results of our study suggest that computer use is the predominant activity for internal medicine residents while in the inpatient setting. Work redesign because of duty hour regulations should consider how to free up residents' time from computer-based activities to allow residents to engage in more direct patient care and noncomputer-based learning.