bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical-Legal Partnerships: Addressing Competency Needs Through Lawyers
Authors: Paul Edward , Fullerton Danya Fortess , Cohen Ellen , Lawton Ellen , Ryan Anne , Sandel Megan 
Published: December 2009

Abstract

Background
Many low- and moderate-income individuals and families have at least one unmet legal need (for example, unsafe housing conditions, lack of access to food and/or income support, lack of access to health care), which, if left unaddressed, can have harmful consequences on health. Eighty unique medical-legal partnership programs, serving over 180 clinics and hospitals nationwide, seek to combine the strengths of medical and legal professionals to address patients' legal needs before they become crises. Each partnership is adapted to serve the specific needs of its own patient base.

Intervention
This article describes innovative, residency-based medical-legal partnership educational experiences in pediatrics, internal medicine, and family medicine at 3 different sites (Boston, Massachusetts; Newark, New Jersey; and Tucson, Arizona). This article addresses how these 3 programs have been designed to meet the Accreditation Council for Graduate Medical Education's 6 competencies, along with suggested methods for evaluating the effectiveness of these programs. Training is a core component of medical-legal partnership, and most medical-legal partnerships have developed curricula for resident education in a variety of formats, including noon conferences, grand rounds, poverty simulations and day-long special sessions.

Discussion
Medical-legal partnerships combine the skill sets of medical professionals and lawyers to teach social determinants of health by training residents and attending physicians to identify and help address unmet legal needs. Medical-legal partnership doctors and lawyers treat health disparities and improve patient health and well-being by ensuring that public programs, regulations, and laws created to benefit health and improve access to health care are implemented and enforced.
Effect of Number of Clinics and Panel Size on Patient Continuity for Medical Residents
Authors: Francis Maureen D. , Zahnd Whitney E. , Varney Andrew , Scaife Steven L. , Francis Mark L. 
Published: December 2009

Abstract

Background
Accreditation Council for Graduate Medical Education program requirements for internal medicine residency training include a longitudinal, continuity experience with a panel of patients.

Objective
To determine whether the number of resident clinics, the resident panel size, and the supervising attending physician affect patient continuity. To determine the number of clinics and the panel size necessary to maximize patient continuity.

Design
We used linear regression modeling to assess the effect of number of attended clinics, the panel size, and the attending physician on patient continuity.

Participants
Forty medicine residents in an academic medicine clinic.

Measurements
Percent patient continuity by the usual provider of care method.

Results
Unadjusted linear regression analysis showed that patient continuity increased 2.3% ± 0.7% for each additional clinic per 9 weeks or 0.4% ± 0.1% for each additional clinic per year (P  =  .003). Conversely, patient continuity decreased 0.7% ± 0.4% for every additional 10 patients in the panel (P  =  .04). When simultaneously controlling for number of clinics, panel size, and attending physician, multivariable linear regression analysis showed that patient continuity increased 3.3% ± 0.5% for each additional clinic per 9 weeks or 0.6% ± 0.1% for each additional clinic per year (P &lt; .001). Conversely, patient continuity decreased 2.2% ± 0.4% for every additional 10 patients in the panel (P &lt; .001). Thus, residents who actually attend at least 1 clinic per week with a panel size less than 106 patients can achieve 50% patient continuity. Interestingly, the attending physician accounted for most of the variability in patient continuity (51%).

Conclusions
Patient continuity for residents significantly increased with increasing numbers of clinics and decreasing panel size and was significantly influenced by the attending physician.
Use of a Postpartum Hemorrhage Simulator for Instruction and Evaluation of Residents
Authors: Deering Shad H. , Chinn Michael , Hodor Jonathon , Benedetti Thomas , Mandel Lynn S. , Goff Barbara 
Published: December 2009

Abstract

Objective
Postpartum hemorrhage is a common and potentially life-threatening obstetric emergency. We sought to create a realistic simulation and validate a standardized grading form to evaluate competency in the management of postpartum hemorrhage.

Methods
Residents from 3 programs underwent training with a postpartum hemorrhage simulation using a standard obstetric birthing model equipped with an inflatable uterus to simulate uterine atony. All simulations were graded by staff physicians with a standardized grading sheet constructed from the current literature on the topic. Residents were expected to recognize the hemorrhage and take appropriate steps, including asking the assistant to administer medications, to correct the problem. Objective and subjective performance was measured with standardized grading sheets, and results were analyzed for reliability using Cronbach α and intraclass correlation coefficients. This project was conducted in accordance with the hospital Institutional Review Board policies at each institution.

Results
Forty residents from 3 institutions underwent simulation training. The majority were unable to correct the hemorrhage within 5 minutes and almost half also made at least 1 error, either the dose or route, in the medications they requested. Reliability was evaluated with Cronbach α and demonstrated the grading sheets were valid and had good interrater reliability.

Discussion
A simulated postpartum hemorrhage scenario can identify important deficiencies in resident knowledge and performance, with no risk to patients. The standardized grading form worked well for our purposes and was reliable in our study. Further testing is needed to evaluate whether the training improves performance in real-life hemorrhages.
Changing the Conversation From Burnout to Wellness: Physician Well-being in Residency Training Programs
Authors: Eckleberry-Hunt Jodie , Van Dyke Anne , Lick David , Tucciarone Jennifer 
Published: December 2009

Abstract

Background
The existing literature either does not address physician wellness or defines it as a lack of burnout. The goal of this article is to call attention to this important gap in the literature and provide ideas for how to fill it. We need a culture change, and we propose that this change begin within graduate medical education.

Methods
We describe a case example of culture change and definitions of wellness at William Beaumont Hospitals, Troy Family Medicine Residency Program, a community-based, university-affiliated program in suburban Detroit, Michigan.

Results
We developed a toolbox of practical steps to create a culture that emphasizes wellness. We present a general timeline illustrating necessary steps toward accomplishing a true cultural change.

Discussion
The time has come for academic medicine to move beyond a simple discussion of physician burnout. To do this, we must first develop a shared definition of physician wellness followed by interventional strategies to bolster it. The benefits of cultural change include providing a more positive educational environment for residents and faculty, raising awareness of burnout and its symptoms, decreasing the stigma associated with admitting burnout symptoms, enabling the development of prevention strategies, and creating a more positive, strength-based approach to understanding the toll of physician-patient relationships on physicians.
Creating a Common Patient Safety Denominator: The Interns' Course
Authors: Shekhter Ilya , Nevo Igal , Fitzpatrick Maureen , Everett-Thomas Ruth , Sanko Jill S. , Birnbach David J. 
Published: December 2009

Abstract

Aim
After finishing medical school, interns are in many ways unprepared for handling patient care challenges independently. Recognizing that interns may benefit from a patient safety orientation, we developed an innovative curriculum to impart competencies related to their role in preventing medical errors. In the course, which runs during the first week of the intern year, we specifically address 1) calling for help; 2) teamwork and communication; 3) hand hygiene compliance; and, 4) preventing medication and other system errors.

Methods
The course consists of a lecture, interactive workshop, and a Web-based didactic component. Small-group simulation sessions allow instructors to assess interns' baseline competence in hand hygiene and patient hand-offs. In an individual exercise, interns performed a directed physical exam on a standardized patient and their hand hygiene adherence was recorded. In a group exercise, team performance was evaluated in accepting a hand-off from another provider and managing a deteriorating patient.

Results
Of the 131 interns, 35% (41) did not wash their hands before and 95% (121) did not wash their hands after patient examination. In the team exercise, scores for 23 teams ranged from 8 to 18 out of 30. None of the participants asked for additional information prior to accepting responsibility for the patient, despite a clearly inadequate hand-off. Post-course surveys indicate that interns consider the course worthwhile: 95% (121) found it beneficial, acquired new teamwork skills, had more appreciation for patient safety, and felt better prepared for clinical duties.

Discussion
We observed serious gaps in hand-hygiene compliance and in communication during hand-offs, both significant impediments to quality patient care. Nevertheless, positive responses to the course from both the interns and the institution reflect an important step in fostering a culture of patient safety.
Grommets and Glue Guns: Standardization of a Pfannenstiel Model for Low-Fidelity Obstetrics-Gynecology Education
Authors: Best Kelly A. , Seibel Brent E. , Lyon Deborah S. 
Published: December 2009

Abstract

Objective
To validate standardized instructions for the creation, implementation, and performance assessment of a low-fidelity model for Pfannenstiel incision.

Study Design
The Pfannenstiel model used at the University of Florida-Jacksonville was broken down into composite steps and constructed by obstetrics-gynecology faculty from across the country. The model was then utilized at participants' home institutions and evaluated with respect to realism of the model, ability to replicate the simulation, appropriateness of the skills checklists, and perceived utility of a publication of similarly catalogued simulation modules for use in obstetrics-gynecology training programs.

Results
The model was correctly constructed by 94.7% (18 of 19) participants and 72.2% (13 of 18) completed a post construction/post simulation survey indicating a high degree of perceived educational utility, feasibility of construction, and desire for additional catalogued modules.

Conclusions
A low-fidelity simulation model was developed, successfully reproduced using inexpensive materials, and implemented across multiple training programs. This model can serve as a template for developing, standardizing and cataloging other low-fidelity simulations for use in resident education. As discussions among medical educators continue regarding further restrictions on duty hours, it is highly likely that more programs will be looking for guidance in establishing quick, inexpensive, and reliable means of developing and assessing surgical skills in their learners. Furthermore, the Accreditation Council for Graduate Medical Education (ACGME) has well-defined goals of programs developing better and more reproducible tools for all of their assessments. For programs with limited resources, preparing and disseminating reproducible, validated tools could be invaluable in complying with future ACGME mandates.
Team Behavior During Trauma Resuscitation: A Simulation-Based Performance Assessment
Authors: Hamilton Nicholas , Freeman Bradley D. , Woodhouse Julie , Ridley Clare , Murray David , Klingensmith Mary E. 
Published: December 2009

Abstract

Introduction
Trauma resuscitations require a coordinated response from a diverse group of health care providers. Currently, there are no widely accepted methods of assessing team effectiveness in this setting. Simulation affords a method to assess team effectiveness. The purpose of this study was to use a simulation setting to develop a specialized assessment instrument for team response in trauma resuscitation.

Methods
We developed our assessment instrument using clinical simulation. Four teams of 3 postgraduate year–2 surgical trainees in conjunction with scripted confederates were videotaped enacting 6 separate trauma resuscitation scenarios that mirrored clinical conditions encountered at our level 1 trauma center. Ten of the resulting videotaped scenarios represented a spectrum of team behavior (ineffective to effective) and were scored by 8 experienced clinicians using the Mayo High Performance Teamwork Scale.

Results
Based in part on the Mayo High Performance Teamwork Scale, we created a prototype trauma team assessment tool consisting of 7 attributes that we scored in binary fashion (present/absent). We validated this prototype by assigning a normalized ranking score to each of the 10 scenarios based on the score supplied by each rater. The presence/absence of the 7 attributes varied significantly among scenarios (52.5% to 93.8%; P &lt; .001). Median scores differed significantly comparing the 5 lowest-ranking scenarios with the 5 highest-ranking scenarios (P &lt; .001).

Conclusion
Our prototype instrument may be effective at assessing team effectiveness during trauma resuscitations. This instrument may prove useful for assessing team competency skills, providing timely feedback to teams, and examining the relationship between effective team function and clinically important outcomes. Further, it may be applicable to other high-acuity, time-sensitive clinical situations.
Expanding the SOAP Note to SOAPS (With S for Safety): A New Era in Real-time Safety Education
Authors: Weiss Patrice M. , Lara-Torre Eduardo , Murchison Amanda B. , Spotswood Laurie 
Published: December 2009

Abstract
The challenges inherent in medical education are multiple, including recognition of different learning styles among students, incorporation of the Accreditation Council for Graduate Medical Education competencies and outcomes measurement into the curriculum, and compliance with mandated duty hours along with a heightened awareness of patient safety required by our regulatory institutions. With the requirement that safety become an explicit part of the residency curriculum across all specialties, educators are charged with innovative ways of achieving this goal. The following commentary addresses this need and suggests an innovative approach to the traditional daily rounds' SOAP (subjective, objective, assessment, and plan) note to incorporate a second S for safety. The use of a SOAPS note elevates each encounter by integrating quality and error avoidance as a component of care. This method teaches the next generation of physicians the importance of patient safety as an integral part of every doctor-patient interaction.
Making Sense: Duty Hours, Work Flow, and Waste in Graduate Medical Education
Authors: Bush Roger W. , Philibert Ingrid 
Published: December 2009

Abstract
Parsimony, and not industry, is the immediate cause of the increase of capital. Industry, indeed, provides the subject which parsimony accumulates. But whatever industry might acquire, if parsimony did not save and store up, the capital would never be the greater.
Adam Smith, The Wealth of Nations, book 2, chapter 31
In 2003, the Accreditation Council for Graduate Medical Education implemented resident duty hour limits that included a weekly limit and limits on continuous hours. Recent recommendations for added reductions in resident duty hours have produced concern about concomitant reductions in future graduates' preparedness for independent practice. The current debate about resident hours largely does not consider whether all hours residents spend in the educational and clinical-care environment contribute meaningfully either to residents' learning or to effective patient care. This may distract the community from waste in the current clinical-education model. We propose that use of “lean production” and quality improvement methods may assist teaching institutions in attaining a deeper understanding of work flow and waste. These methods can be used to assign value to patient- and learner-centered activities and outputs and to optimize the competing and synergistic aspects of all desired outcomes to produce the care the Institute of Medicine recommends: safe, effective, efficient, patient-centered, timely, and equitable. Finally, engagement of senior clinical faculty in determining the culture of the care and education system will contribute to an advanced social-learning and care network.
Burnout During Residency Training: A Literature Review
Authors: IsHak Waguih William , Lederer Sara , Mandili Carla , Nikravesh Rose , Seligman Laurie , Vasa Monisha , Ogunyemi Dotun , Bernstein Carol A. 
Published: December 2009

Abstract

Objective
Burnout is a state of mental and physical exhaustion related to work or care giving activities. Burnout during residency training has gained significant attention secondary to concerns regarding job performance and patient care. This article reviews the relevant literature on burnout in order to provide information to educators about its prevalence, features, impact, and potential interventions.

Methods
Studies were identified through a Medline and PsychInfo search from 1974 to 2009. Fifty-one studies were identified. Definition and description of burnout and measurement methods are presented followed by a thorough review of the studies.

Results
An examination of the burnout literature reveals that it is prevalent in medical students (28%–45%), residents (27%–75%, depending on specialty), as well as practicing physicians. Psychological distress and physical symptoms can impact work performance and patient safety. Distress during medical school can lead to burnout, which in turn can result in negative consequences as a working physician. Burnout also poses significant challenges during early training years in residency. Time demands, lack of control, work planning, work organization, inherently difficult job situations, and interpersonal relationships, are considered factors contributing to residents' burnout. Potential interventions include workplace-driven and individual-driven measures. Workplace interventions include education about burnout, workload modifications, increasing the diversity of work duties, stress management training, mentoring, emotional intelligence training, and wellness workshops. Individual-driven behavioral, social, and physical activities include promoting interpersonal professional relations, meditation, counseling, and exercise.

Conclusions
Educators need to develop an active awareness of burnout and ought to consider incorporating relevant instruction and interventions during the process of training resident physicians.
Simulation for the Training of Human Performance and Technical Skills: The Intersection of How We Will Train Health Care Professionals in the Future
Authors: Hamman William R. , Beaubien Jeffrey M. , Beaudin-Seiler Beth M. 
Published: December 2009

Abstract

Aims
The aims of this research are to begin to understand health care teams in their operational environment, establish metrics of performance for these teams, and validate a series of scenarios in simulation that elicit team and technical skills. The focus is on defining the team model that will function in the operational environment in which health care professionals work.

Methods
Simulations were performed across the United States in 70- to 1000-bed hospitals. Multidisciplinary health care teams analyzed more than 300 hours of videos of health care professionals performing simulations of team-based medical care in several different disciplines. Raters were trained to enhance inter-rater reliability.

Results
The study validated event sets that trigger team dynamics and established metrics for team-based care. Team skills were identified and modified using simulation scenarios that employed the event-set-design process. Specific skills (technical and team) were identified by criticality measurement and task analysis methodology.

Discussion
In situ simulation, which includes a purposeful and Socratic Method of debriefing, is a powerful intervention that can overcome inertia found in clinician behavior and latent environmental systems that present a challenge to quality and patient safety. In situ simulation can increase awareness of risks, personalize the risks, and encourage the reflection, effort, and attention needed to make changes to both behaviors and to systems.
The ACGME Resident Survey Aggregate Reports: An Analysis and Assessment of Overall Program Compliance
Authors: Holt Kathleen D. , Miller Rebecca S. 
Published: December 2009

Abstract

Background
The Accreditation Council for Graduate Medical Education (ACGME) uses a 29-question Resident Survey for yearly residency program assessments. This article describes methodology for aggregating Resident Survey data into 5 discrete areas of program performance for use in the accreditation process. This article also describes methodology for setting thresholds that may assist Residency Review Committees in identifying programs with potential compliance problems.

Methods
A team of ACGME staff and Residency Review Committee chairpersons reviewed the survey for content and proposed thresholds (through a modified Angoff procedure) that would indicate problematic program functioning.

Results
Interrater agreement was high for the 5 content areas and for the threshold values (percentage of noncompliant residents), indicating that programs above these thresholds may warrant follow-up by the accrediting organization. Comparison of the Angoff procedure and the actual distribution of the data revealed that the Angoff thresholds were extremely similar to 1 standard deviation above the content area mean.

Conclusion
Data from the ACGME Resident Survey may be aggregated into internally consistent and consensually valid areas that may help Residency Review Committees make more targeted and specific judgments about program compliance.