WorldWideScience

Sample records for medicine residency training

  1. Hospital Medicine Resident Training Tracks: Developing the Hospital Medicine Pipeline.

    Science.gov (United States)

    Sweigart, Joseph R; Tad-Y, Darlene; Kneeland, Patrick; Williams, Mark V; Glasheen, Jeffrey J

    2017-03-01

    Hospital medicine (HM) is rapidly evolving into new clinical and nonclinical roles. Traditional internal medicine (IM) residency training likely does not optimally prepare residents for success in HM. Hospital medicine residency training tracks may offer a preferred method for specialized HM education. Internet searches and professional networks were used to identify HM training tracks. Information was gathered from program websites and discussions with track directors. The 11 HM tracks at academic medical centers across the United States focus mostly on senior residents. Track structure and curricular content are determined largely by the structure and curricula of the IM residency programs in which they exist. Almost all tracks feature experiential quality improvement projects. Content on healthcare economics and value is common, and numerous track leaders report this content is expanding from HM tracks into entire residency programs. Tracks also provide opportunities for scholarship and professional development, such as workshops on abstract creation and job procurement skills. Almost all tracks include HM preceptorships as well as rotations within various disciplines of HM. HM residency training tracks focus largely on quality improvement, health care economics, and professional development. The structures and curricula of these tracks are tightly linked to opportunities within IM residency programs. As HM continues to evolve, these tracks likely will expand to bridge clinical and extra-clinical gaps between traditional IM training and contemporary HM practice. Journal of Hospital Medicine 2017;12:173-176. © 2017 Society of Hospital Medicine

  2. Family medicine residency training and burnout: a qualitative study.

    Science.gov (United States)

    Rutherford, Kimberly; Oda, Joanna

    2014-01-01

    Almost three-quarters of family practice residents in British Columbia (BC) meet criteria for burnout. We sought to understand how burnout is perceived and experienced by family medicine residents, and to identify both contributory and protective factors for resident burnout. Two semi-structured focus groups were conducted with ten family practice residents from five distinct University of British Columbia training sites. Participants completed the Maslach Burnout Inventory (MBI). The data were analyzed using a thematic analysis approach. Seventy percent of the focus group participants met criteria for burnout using the MBI. The experience of burnout was described as physical and emotional exhaustion, loss of motivation, isolation from loved ones, and disillusionment with the medical profession. Contributory factors included high workload, burned-out colleagues, perceived undervaluing of family medicine, lack of autonomy, and inability to achieve work-life balance. Protective factors included strong role models in medicine, feeling that one's work is valued and rotations in family medicine. The high level of burnout in family medicine residents in BC is a multifactorial and complex phenomenon. Training programs and faculty should be aware of burnout risk factors and strive to implement changes to reduce burnout, including allowing residents increased control over scheduling, access to counseling services and training for resident mentors.

  3. Family medicine residency training and burnout: a qualitative study

    Science.gov (United States)

    Rutherford, Kimberly; Oda, Joanna

    2014-01-01

    Background Almost three-quarters of family practice residents in British Columbia (BC) meet criteria for burnout. We sought to understand how burnout is perceived and experienced by family medicine residents, and to identify both contributory and protective factors for resident burnout. Method Two semi-structured focus groups were conducted with ten family practice residents from five distinct University of British Columbia training sites. Participants completed the Maslach Burnout Inventory (MBI). The data were analyzed using a thematic analysis approach. Results Seventy percent of the focus group participants met criteria for burnout using the MBI. The experience of burnout was described as physical and emotional exhaustion, loss of motivation, isolation from loved ones, and disillusionment with the medical profession. Contributory factors included high workload, burned-out colleagues, perceived undervaluing of family medicine, lack of autonomy, and inability to achieve work-life balance. Protective factors included strong role models in medicine, feeling that one’s work is valued and rotations in family medicine. Conclusions The high level of burnout in family medicine residents in BC is a multifactorial and complex phenomenon. Training programs and faculty should be aware of burnout risk factors and strive to implement changes to reduce burnout, including allowing residents increased control over scheduling, access to counseling services and training for resident mentors. PMID:26451218

  4. Core Content for Wilderness Medicine Training: Development of a Wilderness Medicine Track Within an Emergency Medicine Residency.

    Science.gov (United States)

    Schrading, Walter A; Battaglioli, Nicole; Drew, Jonathan; McClure, Sarah Frances

    2018-03-01

    Wilderness medicine training has become increasingly popular among medical professionals with numerous educational opportunities nationwide. Curricula for fellowship programs and for medical student education have previously been developed and published, but a specific curriculum for wilderness medicine education during emergency medicine (EM) residency has not. The objective of this study is to create a longitudinal wilderness medicine curriculum that can be incorporated into an EM residency program. Interest-specific tracks are becoming increasingly common in EM training. We chose this model to develop our curriculum specific to wilderness medicine. Outlined in the article is a 3-year longitudinal course of study that includes a core didactic curriculum and a plan for graduated level of responsibility. The core content is specifically related to the required EM core content for residency training with additions specific to wilderness medicine for the residents who pursue the track. The wilderness medicine curriculum would give residencies a framework that can be used to foster learning for residents interested in wilderness medicine. It would enhance the coverage of wilderness and environmental core content education for all EM residents in the program. It would provide wilderness-specific education and experience for interested residents, allowing them to align their residency program requirements through a focused area of study and enhancing their curriculum vitae at graduation. Finally, given the popularity of wilderness medicine, the presence of a wilderness medicine track may improve recruitment for the residency program. Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  5. Family medicine residency training and burnout: a qualitative study

    Directory of Open Access Journals (Sweden)

    Kimberly Rutherford

    2014-12-01

    Conclusions: The high level of burnout in family medicine residents in BC is a multifactorial and complex phenomenon. Training programs and faculty should be aware of burnout risk factors and strive to implement changes to reduce burnout, including allowing residents increased control over scheduling, access to counseling services and training for resident mentors.

  6. Training the "assertive practitioner of behavioral science": advancing a behavioral medicine track in a family medicine residency.

    Science.gov (United States)

    Butler, Dennis J; Holloway, Richard L; Fons, Dominique

    2013-01-01

    This article describes the development of a Behavioral Medicine track in a family medicine residency designed to train physicians to proactively and consistently apply advanced skills in psychosocial medicine, psychiatric care, and behavioral medicine. The Behavioral Medicine track emerged from a behavioral science visioning retreat, an opportunity to restructure residency training, a comparative family medicine-psychiatry model, and qualified residents with high interest in behavioral science. Training was restructured to increase rotational opportunities in core behavioral science areas and track residents were provided an intensive longitudinal counseling seminar and received advanced training in psychopharmacology, case supervision, and mindfulness. The availability of a Behavioral Medicine track increased medical student interest in the residency program and four residents have completed the track. All track residents have presented medical Grand Rounds on behavioral science topics and have lead multiple workshops or research sessions at national meetings. Graduate responses indicate effective integration of behavioral medicine skills and abilities in practice, consistent use of brief counseling skills, and good confidence in treating common psychiatric disorders. As developed and structured, the Behavioral Medicine track has achieved the goal of producing "assertive practitioners of behavioral science in family medicine" residents with advanced behavioral science skills and abilities who globally integrate behavioral science into primary care.

  7. Internal Medicine Residents Reject ?Longer and Gentler? Training

    OpenAIRE

    Gopal, R. K.; Carreira, F.; Baker, W. A.; Glasheen, J. J.; Crane, L. A.; Miyoshi, T. J.; Prochazka, A. V.

    2007-01-01

    Background Increasing complexity of medical care, coupled with limits on resident work hours, has prompted consideration of extending Internal Medicine training. It is unclear whether further hour reductions and extension of training beyond the current duration of 3?years would be accepted by trainees. Objective We aimed to determine if further work-hour reductions and extension of training would be accepted by trainees and whether resident burnout affects their opinions. Design A postal surv...

  8. Internal Medicine Residents' Perceptions of Cross-Cultural Training

    Science.gov (United States)

    Park, Elyse R; Betancourt, Joseph R; Miller, Elizabeth; Nathan, Michael; MacDonald, Ellie; Ananeh-Firempong, Owusu; Stone, Valerie E

    2006-01-01

    BACKGROUND Physicians increasingly face the challenge of managing clinical encounters with patients from a range of cultural backgrounds. Despite widespread interest in cross-cultural care, little is known about resident physicians' perceptions of what will best enable them to provide quality care to diverse patient populations. OBJECTIVES To assess medicine residents' (1) perceptions of cross-cultural care, (2) barriers to care, and (3) training experiences and recommendations. DESIGN, SETTING, AND PATIENTS Qualitative individual interviews were conducted with 26 third-year medicine residents at Massachusetts General Hospital in Boston (response rate = 87%). Interviews were recorded, transcribed, and analyzed. RESULTS Despite significant interest in cross-cultural care, almost all of the residents reported very little training during residency. Most had gained cross-cultural skills through informal learning. A few were skeptical about formal training, and some expressed concern that it is impossible to understand every culture. Challenges to the delivery of cross-cultural care included managing patients with limited English proficiency, who involve family in critical decision making, and who have beliefs about disease that vary from the biomedical model. Residents cited many implications to these barriers, ranging from negatively impacting the patient-physician relationship to compromised care. Training recommendations included making changes to the educational climate and informal and formal training mechanisms. CONCLUSIONS If cross-cultural education is to be successful, it must take into account residents' perspectives and be focused on overcoming residents' cited barriers. It is important to convey that cross-cultural education is a set of skills that can be taught and applied, in a time-efficient manner, rather than requiring an insurmountable knowledge base. PMID:16704391

  9. Child abuse training and knowledge: a national survey of emergency medicine, family medicine, and pediatric residents and program directors.

    Science.gov (United States)

    Starling, Suzanne P; Heisler, Kurt W; Paulson, James F; Youmans, Eren

    2009-04-01

    The objective of this study was to determine the level of knowledge, comfort, and training related to the medical management of child abuse among pediatrics, emergency medicine, and family medicine residents. Surveys were administered to program directors and third-year residents at 67 residency programs. The resident survey included a 24-item quiz to assess knowledge regarding the medical management of physical and sexual child abuse. Sites were solicited from members of a network of child abuse physicians practicing at institutions with residency programs. Analyzable surveys were received from 53 program directors and 462 residents. Compared with emergency medicine and family medicine programs, pediatric programs were significantly larger and more likely to have a medical provider specializing in child abuse pediatrics, have faculty primarily responsible for child abuse training, use a written curriculum for child abuse training, and offer an elective rotation in child abuse. Exposure to child abuse training and abused patients was highest for pediatric residents and lowest for family medicine residents. Comfort with managing child abuse cases was lowest among family medicine residents. On the knowledge quiz, pediatric residents significantly outperformed emergency medicine and family medicine residents. Residents with high knowledge scores were significantly more likely to come from larger programs and programs that had a center, provider, or interdisciplinary team that specialized in child abuse pediatrics; had a physician on faculty responsible for child abuse training; used a written curriculum for child abuse training; and had a required rotation in child abuse pediatrics. By analyzing the relationship between program characteristics and residents' child abuse knowledge, we found that pediatric programs provide far more training and resources for child abuse education than emergency medicine and family medicine programs. As leaders, pediatricians must

  10. Sexual Assault Training in Emergency Medicine Residencies: A Survey of Program Directors

    Directory of Open Access Journals (Sweden)

    Margaret K Sande

    2013-09-01

    Full Text Available Introduction: There is currently no standard forensic medicine training program for emergency medicine residents. In the advent of sexual assault nurse examiner (SANE programs aimed at improving the quality of care for sexual assault victims, it is also unclear how these programs impact emergency medicine (EM resident forensic medicine training. The purpose of this study was togather information on EM residency programs’ training in the care of sexual assault patients and determine what impact SANE programs may have on the experience of EM resident training from the perspective of residency program directors (PDs.Methods: This was a cross-sectional survey. The study cohort was all residency PDs from approved EM residency training programs who completed a closed-response self-administered survey electronically.Results: We sent surveys to 152 PDs, and 71 responded for an overall response rate of 47%. Twenty-two PDs (31% reported that their residency does not require procedural competency for the sexual assault exam, and 29 (41% reported their residents are required only to observe sexual assault exam completion to demonstrate competency. Residency PDs were asked how their programs established resident requirements for sexual assault exams. Thirty-seven PDs (52% did not know how their sexual assault exam requirement was established.Conclusion: More than half of residency PDs did not know how their sexual assault guidelines were established, and few were based upon recommendations from the literature. There is no clear consensus as to how PDs view the effect of SANE programs on resident competency with the sexual assault exam. This study highlights both a need for increased awareness of EM resident sexual assault education nationally and also a possible need for a training curriculum defining guidelines forEM residents performing sexual assault exams. [West J Emerg Med. 2013;14(5:461–466.

  11. Four years of training in family medicine: implications for residency redesign.

    Science.gov (United States)

    Sigmon, J Lewis; McPherson, Vanessa; Little, John M

    2012-09-01

    In light of the ongoing consideration for extending the length of residency education in family medicine in the United States, this paper reports the findings from a retrospective, qualitative study of six family physicians that elected to extend their residency training from 3 to 4 years. Each participant completed a written questionnaire and a structured personal interview focusing on various aspects of career development resulting from the additional year of training. The authors independently evaluated these interviews to identify major themes. All the participants were found to have been involved in teaching medicine, valued a more flexible and expanded curriculum, and appreciated their individualized curricula-based on their respective career interests. Given the opportunity, each would opt again for a fourth year of training. There were mixed opinions as to whether the fourth year should be required of all family medicine residents. Other perceived benefits reported were: a better opportunity to find a personally satisfactory practice, additional time for gaining clarity about career plans, and a higher beginning salary as a result of the additional skills and experiences gained. This study of mid-career physicians supports that a fourth-year (PGY4) curriculum in family medicine may enhance subsequent career satisfaction. Further studies of residents in other PGY4 training programs are necessary to assess outcomes comparing our findings as well as guide the discipline's leaders in residency redesign.

  12. Educational contracts in family medicine residency training.

    OpenAIRE

    Mahood, S.; Rojas, R.; Andres, D.; Zagozeski, C.; White, G.; Bradel, T.

    1994-01-01

    An educational contract for family medicine residency training and evaluation addresses many of the difficulties and challenges of current postgraduate medical education. This article identifies important principles for developing a contractual approach; describes the contract used in one program and its implementation; and discusses its theory, advantages, and limitations.

  13. Attitudes of anesthesiology residents toward critical care medicine training.

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    Durbin, C G; McLafferty, C L

    1993-09-01

    The number of anesthesiology residents pursuing critical care medicine (CCM) fellowship training has been decreasing in recent years. A significant number of training positions remain unfilled each year. Possible causes of this decline were evaluated by surveying residents regarding their attitudes toward practice and training in CCM. All 38 anesthesiology programs having accredited CCM fellowships were surveyed. Four of these and one program without CCM fellowships were used to develop the survey instrument. Four programs without CCM fellowships and 34 programs with CCM fellowships make up the survey group. Returned were 640 surveys from 37 (97%) programs accounting for over 30% of the possible residents. Resident interest in pursuing CCM training decreased as year of residency increased (P questions suggested resident concerns with the following: stress of chronic care, financial consequences of additional year of training, ICU call frequency and load, ICU role ambiguity, and shared decision-making in the ICU. A recurring question was, "Are there jobs (outside of academics) for anesthesiologist intensivists?" Most residents knew a CCM anesthesiologist they admired and knew that there were unfilled fellowship positions available. Defining the job market, improving curriculum and teaching, supporting deferment of student loans, and introducing residents and medical students to the ICU earlier may increase the interest in CCM practice among anesthesiology residents.

  14. Training Family Medicine Residents to Perform Home Visits: A CERA Survey.

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    Sairenji, Tomoko; Wilson, Stephen A; D'Amico, Frank; Peterson, Lars E

    2017-02-01

    Home visits have been shown to improve quality of care, save money, and improve outcomes. Primary care physicians are in an ideal position to provide these visits; of note, the Accreditation Council for Graduate Medical Education no longer requires home visits as a component of family medicine residency training. To investigate changes in home visit numbers and expectations, attitudes, and approaches to training among family medicine residency program directors. This research used the Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of family medicine program directors in 2015. Questions addressed home visit practices, teaching and evaluation methods, common types of patient and visit categories, and barriers. There were 252 responses from 455 possible respondents, representing a response rate of 55%. At most programs, residents performed 2 to 5 home visits by graduation in both 2014 (69% of programs, 174 of 252) and 2015 (68%, 172 of 252). The vast majority (68%, 172 of 252) of program directors expect less than one-third of their graduates to provide home visits after graduation. Scheduling difficulties, lack of faculty time, and lack of resident time were the top 3 barriers to residents performing home visits. There appeared to be no decline in resident-performed home visits in family medicine residencies 1 year after they were no longer required. Family medicine program directors may recognize the value of home visits despite a lack of few formal curricula.

  15. Conference attendance does not correlate with emergency medicine residency in-training examination scores.

    Science.gov (United States)

    Gene Hern, H; Wills, Charlotte; Alter, Harrison; Bowman, Steven H; Katz, Eric; Shayne, Philip; Vahidnia, Farnaz

    2009-12-01

    The residency review committee for emergency medicine (EM) requires residents to have greater than 70% attendance of educational conferences during residency training, but it is unknown whether attendance improves clinical competence or scores on the American Board of Emergency Medicine (ABEM) in-training examination (ITE). This study examined the relationship between conference attendance and ITE scores. The hypothesis was that greater attendance would correlate to a higher examination score. This was a multi-center retrospective cohort study using conference attendance data and examination results from residents in four large county EM residency training programs. Longitudinal multi-level models, adjusting for training site, U.S. Medical Licensing Examination (USMLE) Step 1 score, and sex were used to explore the relationship between conference attendance and in-training examination scores according to year of training. Each year of training was studied, as well as the overall effect of mean attendance as it related to examination score. Four training sites reported data on 405 residents during 2002 to 2008; 386 residents had sufficient data to analyze. In the multi-level longitudinal models, attendance at conference was not a significant predictor of in-training percentile score (coefficient = 0.005, 95% confidence interval [CI] = -0.053 to 0.063, p = 0.87). Score on the USMLE Step 1 examination was a strong predictor of ITE score (coefficient = 0.186, 95% CI = 0.155 to 0.217; p ITE scores. Conference attendance may represent an important part of EM residency training but perhaps not of ITE performance. (c) 2009 by the Society for Academic Emergency Medicine.

  16. Disaster Education: A Survey Study to Analyze Disaster Medicine Training in Emergency Medicine Residency Programs in the United States.

    Science.gov (United States)

    Sarin, Ritu R; Cattamanchi, Srihari; Alqahtani, Abdulrahman; Aljohani, Majed; Keim, Mark; Ciottone, Gregory R

    2017-08-01

    The increase in natural and man-made disasters occurring worldwide places Emergency Medicine (EM) physicians at the forefront of responding to these crises. Despite the growing interest in Disaster Medicine, it is unclear if resident training has been able to include these educational goals. Hypothesis This study surveys EM residencies in the United States to assess the level of education in Disaster Medicine, to identify competencies least and most addressed, and to highlight effective educational models already in place. The authors distributed an online survey of multiple-choice and free-response questions to EM residency Program Directors in the United States between February 7 and September 24, 2014. Questions assessed residency background and details on specific Disaster Medicine competencies addressed during training. Out of 183 programs, 75 (41%) responded to the survey and completed all required questions. Almost all programs reported having some level of Disaster Medicine training in their residency. The most common Disaster Medicine educational competencies taught were patient triage and decontamination. The least commonly taught competencies were volunteer management, working with response teams, and special needs populations. The most commonly identified methods to teach Disaster Medicine were drills and lectures/seminars. There are a variety of educational tools used to teach Disaster Medicine in EM residencies today, with a larger focus on the use of lectures and hospital drills. There is no indication of a uniform educational approach across all residencies. The results of this survey demonstrate an opportunity for the creation of a standardized model for resident education in Disaster Medicine. Sarin RR , Cattamanchi S , Alqahtani A , Aljohani M , Keim M , Ciottone GR . Disaster education: a survey study to analyze disaster medicine training in emergency medicine residency programs in the United States. Prehosp Disaster Med. 2017;32(4):368-373.

  17. A comparison of surgery and family medicine residents' perceptions of cross-cultural care training.

    Science.gov (United States)

    Chun, Maria B J; Jackson, David S; Lin, Susan Y; Park, Elyse R

    2010-12-01

    The need for physicians formally trained to deliver care to diverse patient populations has been widely advocated. Utilizing a validated tool, Weissman and Betancourt's Cross-Cultural Care Survey, the aim of this current study was to compare surgery and family medicine residents' perceptions of their preparedness and skillfulness to provide high quality cross-cultural care. Past research has documented differences between the two groups' reported impressions of importance and level of instruction received in cross-cultural care. Twenty surgery and 15 family medicine residents participated in the study. Significant differences were found between surgery and family medicine residents on most ratings of the amount of training they received in cross-cultural skills. Specifically, family medicine residents reported having received more training on: 1) determining how patients want to be addressed, 2) taking a social history, 3) assessing their understanding of the cause of illness, 4) negotiating their treatment plan, 5) assessing whether they are mistrustful of the health care system and÷or doctor, 6) identifying cultural customs, 7) identifying how patients make decisions within the family, and 8) delivering services through a medical interpreter. One unexpected finding was that surgery residents, who reported not receiving much formal cultural training, reported higher mean scores on perceived skillfulness (i.e. ability) than family medicine residents. The disconnect may be linked to the family medicine residents' training in cultural humility - more knowledge and understanding of cross-cultural care can paradoxically lead to perceptions of being less prepared or skillful in this area. Hawaii Medical Journal Copyright 2010.

  18. Experience with Emergency Ultrasound Training by Canadian Emergency Medicine Residents

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    Daniel J. Kim

    2014-05-01

    Full Text Available Introduction: Starting in 2008, emergency ultrasound (EUS was introduced as a core competency to the Royal College of Physicians and Surgeons of Canada (Royal College emergency medicine (EM training standards. The Royal College accredits postgraduate EM specialty training in Canada through 5-year residency programs. The objective of this study is to describe both the current experience with and the perceptions of EUS by Canadian Royal College EM senior residents. Methods: This was a web-based survey conducted from January to March 2011 of all 39 Canadian Royal College postgraduate fifth-year (PGY-5 EM residents. Main outcome measures were characteristics of EUS training and perceptions of EUS. Results: Survey response rate was 95% (37/39. EUS was part of the formal residency curriculum for 86% of respondents (32/37. Residents most commonly received training in focused assessment with sonography for trauma, intrauterine pregnancy, abdominal aortic aneurysm, cardiac, and procedural guidance. Although the most commonly provided instructional material (86% [32/37] was an ultrasound course, 73% (27/37 of residents used educational resources outside of residency training to supplement their ultrasound knowledge. Most residents (95% [35/37] made clinical decisions and patient dispositions based on their EUS interpretation without a consultative study by radiology. Residents had very favorable perceptions and opinions of EUS. Conclusion: EUS training in Royal College EM programs was prevalent and perceived favorably by residents, but there was heterogeneity in resident training and practice of EUS. This suggests variability in both the level and quality of EUS training in Canadian Royal College EM residency programs.

  19. Evaluating residents in the nuclear medicine residency training program: an educational perspective

    International Nuclear Information System (INIS)

    Pascual, T.N.; San Luis, T.O.L.; Leus, M.

    2007-01-01

    Full text: The comprehensive evaluation of medical residents in a residency-training program includes the use of educational tools to measure the attainment of competencies in the cognitive, psychomotor and affective domains as prescribed in the training curriculum. Attention is almost always focused on the testing of cognitive domain of the learners with limited attention given on the psychomotor and affective parameters, which are in fact, together with the cognitive domain, integral to the students' learning behaviour. This paper aims to review the principles of test construction, including the perspectives on the roles, types and purpose of tests in the domains of learning (cognitive, psychomotor and affective) as well as the use of Non-Test materials for measuring affective learning outcomes and the construction of Performance Tests and Portfolio Assessment tools which are all essential for the effective and efficient evaluation of residents in a Nuclear Medicine Training Program. (author)

  20. The research rotation: competency-based structured and novel approach to research training of internal medicine residents

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    Dimitrov Vihren

    2006-10-01

    Full Text Available Abstract Background In the United States, the Accreditation Council of graduate medical education (ACGME requires all accredited Internal medicine residency training programs to facilitate resident scholarly activities. However, clinical experience and medical education still remain the main focus of graduate medical education in many Internal Medicine (IM residency-training programs. Left to design the structure, process and outcome evaluation of the ACGME research requirement, residency-training programs are faced with numerous barriers. Many residency programs report having been cited by the ACGME residency review committee in IM for lack of scholarly activity by residents. Methods We would like to share our experience at Lincoln Hospital, an affiliate of Weill Medical College Cornell University New York, in designing and implementing a successful structured research curriculum based on ACGME competencies taught during a dedicated "research rotation". Results Since the inception of the research rotation in 2004, participation of our residents among scholarly activities has substantially increased. Our residents increasingly believe and appreciate that research is an integral component of residency training and essential for practice of medicine. Conclusion Internal medicine residents' outlook in research can be significantly improved using a research curriculum offered through a structured and dedicated research rotation. This is exemplified by the improvement noted in resident satisfaction, their participation in scholarly activities and resident research outcomes since the inception of the research rotation in our internal medicine training program.

  1. A Comparison of Surgery and Family Medicine Residents' Perceptions of Cross-Cultural Care Training of Cross-Cultural Care Training

    Science.gov (United States)

    Jackson, David S; Lin, Susan Y; Park, Elyse R

    2010-01-01

    The need for physicians formally trained to deliver care to diverse patient populations has been widely advocated. Utilizing a validated tool, Weissman and Betancourt's Cross-Cultural Care Survey, the aim of this current study was to compare surgery and family medicine residents' perceptions of their preparedness and skillfulness to provide high quality cross-cultural care. Past research has documented differences between the two groups' reported impressions of importance and level of instruction received in cross-cultural care. Twenty surgery and 15 family medicine residents participated in the study. Significant differences were found between surgery and family medicine residents on most ratings of the amount of training they received in cross-cultural skills. Specifically, family medicine residents reported having received more training on: 1) determining how patients want to be addressed, 2) taking a social history, 3) assessing their understanding of the cause of illness, 4) negotiating their treatment plan, 5) assessing whether they are mistrustful of the health care system and/or doctor, 6) identifying cultural customs, 7) identifying how patients make decisions within the family, and 8) delivering services through a medical interpreter. One unexpected finding was that surgery residents, who reported not receiving much formal cultural training, reported higher mean scores on perceived skillfulness (i.e. ability) than family medicine residents. The disconnect may be linked to the family medicine residents' training in cultural humility — more knowledge and understanding of cross-cultural care can paradoxically lead to perceptions of being less prepared or skillful in this area. PMID:21225585

  2. Measuring Value in Internal Medicine Residency Training Hospitals Using Publicly Reported Measures.

    Science.gov (United States)

    Schickedanz, Adam; Gupta, Reshma; Arora, Vineet M; Braddock, Clarence H

    2018-03-01

    Graduate medical education (GME) lacks measures of resident preparation for high-quality, cost-conscious practice. The authors used publicly reported teaching hospital value measures to compare internal medicine residency programs on high-value care training and to validate these measures against program director perceptions of value. Program-level value training scores were constructed using Centers for Medicare & Medicaid Services Value-Based Purchasing (VBP) Program hospital quality and cost-efficiency data. Correlations with Association of Program Directors in Internal Medicine Annual Survey high-value care training measures were examined using logistic regression. For every point increase in program-level VBP score, residency directors were more likely to agree that GME programs have a responsibility to contain health care costs (adjusted odds ratio [aOR] 1.18, P = .04), their faculty model high-value care (aOR 1.07, P = .03), and residents are prepared to make high-value medical decisions (aOR 1.07, P = .09). Publicly reported clinical data offer valid measures of GME value training.

  3. Competency-based evaluation tools for integrative medicine training in family medicine residency: a pilot study

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    Schneider Craig

    2007-04-01

    Full Text Available Abstract Background As more integrative medicine educational content is integrated into conventional family medicine teaching, the need for effective evaluation strategies grows. Through the Integrative Family Medicine program, a six site pilot program of a four year residency training model combining integrative medicine and family medicine training, we have developed and tested a set of competency-based evaluation tools to assess residents' skills in integrative medicine history-taking and treatment planning. This paper presents the results from the implementation of direct observation and treatment plan evaluation tools, as well as the results of two Objective Structured Clinical Examinations (OSCEs developed for the program. Methods The direct observation (DO and treatment plan (TP evaluation tools developed for the IFM program were implemented by faculty at each of the six sites during the PGY-4 year (n = 11 on DO and n = 8 on TP. The OSCE I was implemented first in 2005 (n = 6, revised and then implemented with a second class of IFM participants in 2006 (n = 7. OSCE II was implemented in fall 2005 with only one class of IFM participants (n = 6. Data from the initial implementation of these tools are described using descriptive statistics. Results Results from the implementation of these tools at the IFM sites suggest that we need more emphasis in our curriculum on incorporating spirituality into history-taking and treatment planning, and more training for IFM residents on effective assessment of readiness for change and strategies for delivering integrative medicine treatment recommendations. Focusing our OSCE assessment more narrowly on integrative medicine history-taking skills was much more effective in delineating strengths and weaknesses in our residents' performance than using the OSCE for both integrative and more basic communication competencies. Conclusion As these tools are refined further they will be of value both in improving

  4. Promoting addiction medicine teaching through functional mentoring by co-training generalist chief residents with faculty mentors.

    Science.gov (United States)

    Alford, Daniel P; Carney, Brittany L; Jackson, Angela H; Brett, Belle; Bridden, Carly; Winter, Michael; Samet, Jeffrey H

    2018-02-16

    Generalist physicians should play a vital role in identifying and managing individuals with substance use but are inadequately trained to do so. This 5-year (2008-2012) controlled educational study assessed whether internal medicine and family medicine chief residents' (CRs) addiction medicine teaching increased by co-training with faculty mentors at a Chief Resident Immersion Training (CRIT) program in addiction medicine. All CRIT CR attendees identified a residency program faculty mentor to support addiction medicine teaching after CRIT through functional mentoring with a focus on developing and implementing an Addiction Medicine Teaching Project ("Teaching Project"). Approximately half of the CRs attended CRIT with their mentor (co-trained) and half without their mentor (solo-trained). Addiction medicine teaching outcomes were compared between groups using 6- and 11-month questionnaires and 4 bimonthly teaching logs. Of co-trained CRs, mentor characteristics that positively influenced addiction medicine teaching outcomes were identified. One hundred CRs from 74 residency programs attended CRIT from 2008 to 2012; 47 co-trained with their mentors and 53 solo-trained without their mentors. At 6-month follow-up, the co-trained CRs were more likely to meet at least monthly with their mentor (22.7% vs. 9.6%, P mentor as a facilitator for Teaching Project implementation (82.2% vs. 38.5%, P Mentors with more experience, including years of teaching, was associated with better CR Teaching Project outcomes. Co-training generalist chief residents with a faculty mentor appeared to facilitate functional mentoring-driven Teaching Project implementation but did not further increase already high levels of other addiction medicine teaching. Faculty mentors with more years of teaching experience were more effective in facilitating Teaching Project implementation.

  5. Charting the Road to Competence: Developmental Milestones for Internal Medicine Residency Training

    Science.gov (United States)

    Green, Michael L.; Aagaard, Eva M.; Caverzagie, Kelly J.; Chick, Davoren A.; Holmboe, Eric; Kane, Gregory; Smith, Cynthia D.; Iobst, William

    2009-01-01

    Background The Accreditation Council for Graduate Medical Education (ACGME) Outcome Project requires that residency program directors objectively document that their residents achieve competence in 6 general dimensions of practice. Intervention In November 2007, the American Board of Internal Medicine (ABIM) and the ACGME initiated the development of milestones for internal medicine residency training. ABIM and ACGME convened a 33-member milestones task force made up of program directors, experts in evaluation and quality, and representatives of internal medicine stakeholder organizations. This article reports on the development process and the resulting list of proposed milestones for each ACGME competency. Outcomes The task force adopted the Dreyfus model of skill acquisition as a framework the internal medicine milestones, and calibrated the milestones with the expectation that residents achieve, at a minimum, the “competency” level in the 5-step progression by the completion of residency. The task force also developed general recommendations for strategies to evaluate the milestones. Discussion The milestones resulting from this effort will promote competency-based resident education in internal medicine, and will allow program directors to track the progress of residents and inform decisions regarding promotion and readiness for independent practice. In addition, the milestones may guide curriculum development, suggest specific assessment strategies, provide benchmarks for resident self-directed assessment-seeking, and assist remediation by facilitating identification of specific deficits. Finally, by making explicit the profession's expectations for graduates and providing a degree of national standardization in evaluation, the milestones may improve public accountability for residency training. PMID:21975701

  6. Psychiatry Training in Canadian Family Medicine Residency Programs

    OpenAIRE

    Kates, Nick; Toews, John; Leichner, Pierre

    1985-01-01

    Family physicians may spend up to 50% of their time diagnosing and managing mental disorders and emotional problems, but this is not always reflected in the training they receive. This study of the teaching of psychiatry in the 16 family medicine residency programs in Canada showed that although the majority of program directors are reasonably satisfied with the current training, they see room for improvement—particularly in finding psychiatrists with a better understanding of family practice...

  7. General medicine vs subspecialty career plans among internal medicine residents.

    Science.gov (United States)

    West, Colin P; Dupras, Denise M

    2012-12-05

    Current medical training models in the United States are unlikely to produce sufficient numbers of general internists and primary care physicians. Differences in general internal medicine (GIM) career plans between internal medicine residency program types and across resident demographics are not well understood. To evaluate the general medicine career plans of internal medicine residents and how career plans evolve during training. A study of US internal medicine residents using an annual survey linked to the Internal Medicine In-Training Examination taken in October of 2009-2011 to evaluate career plans by training program, sex, and medical school location. Of 67,207 US eligible categorical and primary care internal medicine residents, 57,087 (84.9%) completed and returned the survey. Demographic data provided by the National Board of Medical Examiners were available for 52,035 (77.4%) of these residents, of whom 51,390 (76.5%) responded to all survey items and an additional 645 (1.0%) responded to at least 1 survey item. Data were analyzed from the 16,781 third-year residents (32.2%) in this sample. Self-reported ultimate career plans of internal medicine residents. A GIM career plan was reported by 3605 graduating residents (21.5%). A total of 562 primary care program (39.6%) and 3043 categorical (19.9%) residents reported GIM as their ultimate career plan (adjusted odds ratio [AOR], 2.76; 99% CI, 2.35-3.23; P international medical graduates (22.0% vs 21.1%, respectively; AOR, 1.76; 99% CI, 1.50-2.06; P international medical graduates (57.3% vs 27.3%, respectively; AOR, 3.48; 99% CI, 2.58-4.70; P internal medicine residents, including those in primary care training programs, and differed according to resident sex, medical school location, and program type.

  8. Leadership training in a family medicine residency program: Cross-sectional quantitative survey to inform curriculum development.

    Science.gov (United States)

    Gallagher, Erin; Moore, Ainsley; Schabort, Inge

    2017-03-01

    To assess the current status of leadership training as perceived by family medicine residents to inform the development of a formal leadership curriculum. Cross-sectional quantitative survey. Department of Family Medicine at McMaster University in Hamilton, Ont, in December 2013. A total of 152 first- and second-year family medicine residents. Family medicine residents' attitudes toward leadership, perceived level of training in various leadership domains, and identified opportunities for leadership training. Overall, 80% (152 of 190) of residents completed the survey. On a Likert scale (1 = strongly disagree, 4 = neutral, 7 = strongly agree), residents rated the importance of physician leadership in the clinical setting as high (6.23 of 7), whereas agreement with the statement "I am a leader" received the lowest rating (5.28 of 7). At least 50% of residents desired more training in the leadership domains of personal mastery, mentorship and coaching, conflict resolution, teaching, effective teamwork, administration, ideals of a healthy workplace, coalitions, and system transformation. At least 50% of residents identified behavioural sciences seminars, a lecture and workshop series, and a retreat as opportunities to expand leadership training. The concept of family physicians as leaders resonated highly with residents. Residents desired more personal and system-level leadership training. They also identified ways that leadership training could be expanded in the current curriculum and developed in other areas. The information gained from this survey might facilitate leadership development among residents through application of its results in a formal leadership curriculum. Copyright© the College of Family Physicians of Canada.

  9. Training family medicine residents to practice collaboratively with psychology trainees.

    Science.gov (United States)

    Porcerelli, John H; Fowler, Shannon L; Murdoch, William; Markova, Tsveti; Kimbrough, Christina

    2013-01-01

    This article will describe a training curriculum for family medicine residents to practice collaboratively with psychology (doctoral) trainees at the Wayne State University/Crittenton Family Medicine Residency program. The collaborative care curriculum involves a series of patient care and educational activities that require collaboration between family medicine residents and psychology trainees. Activities include: (1) clinic huddle, (2) shadowing, (3) pull-ins and warm handoffs, (4) co-counseling, (5) shared precepting, (6) feedback from psychology trainees to family medicine residents regarding consults, brief interventions, and psychological testing, (7) lectures, (8) video-observation and feedback, (9) home visits, and (10) research. The activities were designed to teach the participants to work together as a team and to provide a reciprocal learning experience. In a brief three-item survey of residents at the end of their academic year, 83% indicated that they had learned new information or techniques from working with the psychology trainees for assessment and intervention purposes; 89% indicated that collaborating with psychology trainees enhanced their patient care; and 89% indicated that collaborating with psychology trainees enhanced their ability to work as part of a team. Informal interviews with the psychology trainees indicated that reciprocal learning had taken place. Family medicine residents can learn to work collaboratively with psychology trainees through a series of shared patient care and educational activities within a primary care clinic where an integrated approach to care is valued.

  10. A Novel Approach to Medicine Training for Psychiatry Residents

    Science.gov (United States)

    Onate, John; Hales, Robert; McCarron, Robert; Han, Jaesu; Pitman, Dorothy

    2008-01-01

    Objective: A unique rotation was developed to address limited outpatient internal medicine training in psychiatric residency by the University of California, Davis, Department of Psychiatry and Behavioral Sciences, which provides medical care to patients with mental illness. Methods: The number of patients seen by the service and the number of…

  11. Changing the formula of residents' work hours in internal medicine: moving from "years in training" to "hours in training".

    Science.gov (United States)

    Mansi, Ishak A

    2011-03-01

    In a recent report, the Institute of Medicine recommended more restrictions on residents' working hours. Several problems exist with a system that places a weekly limit on resident duty hours: (1) it assumes the presence of a linear relationship between hours of work and patient safety; (2) it fails to consider differences in intensity among programs; and (3) it does not address increases in the scientific content of medicine, and it places the burden of enforcing the duty hour limits on the Accreditation Council for Graduate Medical Education. An innovative method of calculating credit hours for graduate medical education would shift the focus from "years of residency" to "hours of residency." For example, internal medicine residents would be requested to spend 8640 hours of total training hours (assuming 60 hours per week for 48 weeks annually) instead of the traditional 3 years. This method of counting training hours is used by other professions, such as the Intern Development Program of the National Council of Architectural Registration Boards. The proposed approach would allow residents and program directors to pace training based on individual capabilities. Standards for resident education should include the average number of patients treated in each setting (inpatient or outpatient). A possible set of "multipliers" based on these parameters, and possibly others such as resident evaluation, is devised to calculate the "final adjusted accredited hours" that count toward graduation. Substituting "years of training" with "hours of training" may resolve many of the concerns with the current residency education model, as well as adapt to the demands of residents' personal lives. It also may allow residents to pace their training according to their capabilities and learning styles, and contribute to reflective learning and better quality education.

  12. Internal medicine residency training for unhealthy alcohol and other drug use: recommendations for curriculum design

    Science.gov (United States)

    2010-01-01

    Background Unhealthy substance use is the spectrum from use that risks harm, to use associated with problems, to the diagnosable conditions of substance abuse and dependence, often referred to as substance abuse disorders. Despite the prevalence and impact of unhealthy substance use, medical education in this area remains lacking, not providing physicians with the necessary expertise to effectively address one of the most common and costly health conditions. Medical educators have begun to address the need for physician training in unhealthy substance use, and formal curricula have been developed and evaluated, though broad integration into busy residency curricula remains a challenge. Discussion We review the development of unhealthy substance use related competencies, and describe a curriculum in unhealthy substance use that integrates these competencies into internal medicine resident physician training. We outline strategies to facilitate adoption of such curricula by the residency programs. This paper provides an outline for the actual implementation of the curriculum within the structure of a training program, with examples using common teaching venues. We describe and link the content to the core competencies mandated by the Accreditation Council for Graduate Medical Education, the formal accrediting body for residency training programs in the United States. Specific topics are recommended, with suggestions on how to integrate such teaching into existing internal medicine residency training program curricula. Summary Given the burden of disease and effective interventions available that can be delivered by internal medicine physicians, teaching about unhealthy substance use must be incorporated into internal medicine residency training, and can be done within existing teaching venues. PMID:20230607

  13. Teaching-skills training programs for family medicine residents: systematic review of formats, content, and effects of existing programs.

    Science.gov (United States)

    Lacasse, Miriam; Ratnapalan, Savithiri

    2009-09-01

    To review the literature on teaching-skills training programs for family medicine residents and to identify formats and content of these programs and their effects. Ovid MEDLINE (1950 to mid-July 2008) and the Education Resources Information Center database (pre-1966 to mid-July 2008) were searched using and combining the MeSH terms teaching, internship and residency, and family practice; and teaching, graduate medical education, and family practice. The initial MEDLINE and Education Resources Information Center database searches identified 362 and 33 references, respectively. Titles and abstracts were reviewed and studies were included if they described the format or content of a teaching-skills program or if they were primary studies of the effects of a teaching-skills program for family medicine residents or family medicine and other specialty trainees. The bibliographies of those articles were reviewed for unidentified studies. A total of 8 articles were identified for systematic review. Selection was limited to articles published in English. Teaching-skills training programs for family medicine residents vary from half-day curricula to a few months of training. Their content includes leadership skills, effective clinical teaching skills, technical teaching skills, as well as feedback and evaluation skills. Evaluations mainly assessed the programs' effects on teaching behaviour, which was generally found to improve following participation in the programs. Evaluations of learner reactions and learning outcomes also suggested that the programs have positive effects. Family medicine residency training programs differ from all other residency training programs in their shorter duration, usually 2 years, and the broader scope of learning within those 2 years. Few studies on teaching-skills training, however, were designed specifically for family medicine residents. Further studies assessing the effects of teaching-skills training in family medicine residents are

  14. Psychosocial Training in U.S. Internal Medicine and Family Practice Residency Programs.

    Science.gov (United States)

    Gaufberg, Elizabeth H.; Joseph, Robert C.; Pels, Richard J.; Wyshak, Grace; Wieman, Dow; Nadelson, Carol C.

    2001-01-01

    Surveyed directors of internal medicine (IM) and family practice (FP) residency programs regarding the format, content, and quantity of psychosocial training in their programs, their opinions on topics related to such training, and program demographics. Found considerable variation in content and time devoted to psychosocial training within and…

  15. The effect of a simple educational intervention on interest in early abortion training among family medicine residents.

    Science.gov (United States)

    Wu, Justine P; Bennett, Ian; Levine, Jeffrey P; Aguirre, Abigail Calkins; Bellamy, Scarlett; Fleischman, Joan

    2006-06-01

    We aimed to assess the effect of an educational intervention on the interest in and support for abortion training among family medicine residents. We conducted a cross-sectional survey before and after an educational lecture on medical and surgical abortion in primary care among 89 residents in 10 New Jersey family medicine programs. Before the lecture, there was more interest in medical abortion training than surgical abortion. Resident interest in surgical abortion and overall support for abortion training increased after the educational intervention (p<.01). Efforts to develop educational programs on early abortion care may facilitate the integration of abortion training in family medicine.

  16. Psychiatry training in canadian family medicine residency programs.

    Science.gov (United States)

    Kates, N; Toews, J; Leichner, P

    1985-01-01

    Family physicians may spend up to 50% of their time diagnosing and managing mental disorders and emotional problems, but this is not always reflected in the training they receive. This study of the teaching of psychiatry in the 16 family medicine residency programs in Canada showed that although the majority of program directors are reasonably satisfied with the current training, they see room for improvement-particularly in finding psychiatrists with a better understanding of family practice, in integrating the teaching to a greater degree with clinical work, thereby increasing its relevance, and in utilizing more suitable clinical settings.

  17. Lifestyle medicine curriculum for a preventive medicine residency program: implementation and outcomes.

    Science.gov (United States)

    Nawaz, Haq; Petraro, Paul V; Via, Christina; Ullah, Saif; Lim, Lionel; Wild, Dorothea; Kennedy, Mary; Phillips, Edward M

    2016-01-01

    The vast majority of the healthcare problems burdening our society today are caused by disease-promoting lifestyles (e.g., physical inactivity and unhealthy eating). Physicians report poor training and lack of confidence in counseling patients on lifestyle changes. To evaluate a new curriculum and rotation in lifestyle medicine for preventive medicine residents. Training included didactics (six sessions/year), distance learning, educational conferences, and newly developed lifestyle medicine rotations at the Institute of Lifestyle Medicine, the Yale-Griffin Prevention Research Center, and the Integrative Medicine Center. We used a number of tools to assess residents' progress including Objective Structured Clinical Examinations (OSCEs), self-assessments, and logs of personal health habits. A total of 20 residents participated in the lifestyle medicine training between 2010 and 2013. There was a 15% increase in residents' discussions of lifestyle issues with their patients based on their baseline and follow-up surveys. The performance of preventive medicine residents on OSCEs increased each year they were in the program (average OSCE score: PGY1 73%, PGY2 83%, PGY3 87%, and PGY4 91%, p=0.01). Our internal medicine and preliminary residents served as a control, since they did participate in didactics but not in lifestyle medicine rotations. Internal medicine and preliminary residents who completed the same OSCEs had a slightly lower average score (76%) compared with plural for resident, preventive medicine residents (80%). However, this difference did not reach statistical significance (p=0.11). Incorporating the lifestyle medicine curriculum is feasible for preventive medicine training allowing residents to improve their health behavior change discussions with patients as well as their own personal health habits.

  18. Training on the clock: family medicine residency directors' responses to resident duty hours reform.

    Science.gov (United States)

    Peterson, Lars E; Johnson, Hillary; Pugno, Perry A; Bazemore, Andrew; Phillips, Robert L

    2006-12-01

    The Accreditation Council for Graduate Medical Education's 2003 restrictions on resident duty hours (RDH) raised concerns among educators about potential negative impacts on residents' training. In the early wake of these restrictions, little is known about how RDH reform impacts training in primary care. The authors surveyed family medicine (FM) residency program directors (PDs) for their perceptions of the impact of RDH regulations on training in primary care. All PDs of 472 FM residency programs were asked via list-serve to complete an anonymous Internet-based survey in the fall of 2004. The survey solicited PDs' opinions about changes in staff and in residents' training experiences with respect to implementation of RDH regulations. Descriptive and qualitative analyses were conducted. There were 369 partial and 328 complete responses, for a response rate of 69% (328/472). Effects of the RDH regulations are varied. Fifty percent of FMPDs report increased patient-care duties for attendings, whereas 42% report no increase. Nearly 80% of programs hired no additional staff. Sixty percent of programs eliminated postcall clinics, and nearly 40% implemented a night-float system. Administrative hassles and losses of professionalism, educational opportunity, and continuity of care were common concerns, but a sizeable minority feel that residents will be better off under the new regulations. Many FMPDs cited increased faculty burden and the risk of lower-quality educational experiences for their trainees. Innovations for increasing the effectiveness of teaching may ultimately compensate for lost educational time. If not, alternatives such as extending the length of residency must be considered.

  19. Impact of Residency Training Redesign on Residents' Clinical Knowledge.

    Science.gov (United States)

    Waller, Elaine; Eiff, M Patrice; Dexter, Eve; Rinaldo, Jason C B; Marino, Miguel; Garvin, Roger; Douglass, Alan B; Phillips, Robert; Green, Larry A; Carney, Patricia A

    2017-10-01

    The In-training Examination (ITE) is a frequently used method to evaluate family medicine residents' clinical knowledge. We compared family medicine ITE scores among residents who trained in the 14 programs that participated in the Preparing the Personal Physician for Practice (P4) Project to national averages over time, and according to educational innovations. The ITE scores of 802 consenting P4 residents who trained in 2007 through 2011 were obtained from the American Board of Family Medicine. The primary analysis involved comparing scores within each academic year (2007 through 2011), according to program year (PGY) for P4 residents to all residents nationally. A secondary analysis compared ITE scores among residents in programs that experimented with length of training and compared scores among residents in programs that offered individualized education options with those that did not. Release of ITE scores was consented to by 95.5% of residents for this study. Scores of P4 residents were higher compared to national scores in each year. For example, in 2011, the mean P4 score for PGY1 was 401.2, compared to the national average of 386. For PGY2, the mean P4 score was 443.1, compared to the national average of 427, and for PGY3, the mean P4 score was 477.0, compared to the national PGY3 score of 456. Scores of residents in programs that experimented with length of training were similar to those in programs that did not. Scores were also similar between residents in programs with and without individualized education options. Family medicine residency programs undergoing substantial educational changes, including experiments in length of training and individualized education, did not appear to experience a negative effect on resident's clinical knowledge, as measured by ITE scores. Further research is needed to study the effect of a wide range of residency training innovations on ITE scores over time.

  20. Training in childhood obesity management in the United States: a survey of pediatric, internal medicine-pediatrics and family medicine residency program directors.

    Science.gov (United States)

    Wolff, Margaret S; Rhodes, Erinn T; Ludwig, David S

    2010-02-17

    Information about the availability and effectiveness of childhood obesity training during residency is limited. We surveyed residency program directors from pediatric, internal medicine-pediatrics (IM-Peds), and family medicine residency programs between September 2007 and January 2008 about childhood obesity training offered in their programs. The response rate was 42.2% (299/709) and ranged by specialty from 40.1% to 45.4%. Overall, 52.5% of respondents felt that childhood obesity training in residency was extremely important, and the majority of programs offered training in aspects of childhood obesity management including prevention (N = 240, 80.3%), diagnosis (N = 282, 94.3%), diagnosis of complications (N = 249, 83.3%), and treatment (N = 242, 80.9%). However, only 18.1% (N = 54) of programs had a formal childhood obesity curriculum with variability across specialties. Specifically, 35.5% of IM-Peds programs had a formal curriculum compared to only 22.6% of pediatric and 13.9% of family medicine programs (p obesity training was competing curricular demands (58.5%). While most residents receive training in aspects of childhood obesity management, deficits may exist in training quality with a minority of programs offering a formal childhood obesity curriculum. Given the high prevalence of childhood obesity, a greater emphasis should be placed on development and use of effective training strategies suitable for all specialties training physicians to care for children.

  1. Lifestyle medicine curriculum for a preventive medicine residency program: implementation and outcomes

    Science.gov (United States)

    Nawaz, Haq; Petraro, Paul V.; Via, Christina; Ullah, Saif; Lim, Lionel; Wild, Dorothea; Kennedy, Mary; Phillips, Edward M.

    2016-01-01

    Background The vast majority of the healthcare problems burdening our society today are caused by disease-promoting lifestyles (e.g., physical inactivity and unhealthy eating). Physicians report poor training and lack of confidence in counseling patients on lifestyle changes. Objective To evaluate a new curriculum and rotation in lifestyle medicine for preventive medicine residents. Methods Training included didactics (six sessions/year), distance learning, educational conferences, and newly developed lifestyle medicine rotations at the Institute of Lifestyle Medicine, the Yale-Griffin Prevention Research Center, and the Integrative Medicine Center. We used a number of tools to assess residents’ progress including Objective Structured Clinical Examinations (OSCEs), self-assessments, and logs of personal health habits. Results A total of 20 residents participated in the lifestyle medicine training between 2010 and 2013. There was a 15% increase in residents’ discussions of lifestyle issues with their patients based on their baseline and follow-up surveys. The performance of preventive medicine residents on OSCEs increased each year they were in the program (average OSCE score: PGY1 73%, PGY2 83%, PGY3 87%, and PGY4 91%, p=0.01). Our internal medicine and preliminary residents served as a control, since they did participate in didactics but not in lifestyle medicine rotations. Internal medicine and preliminary residents who completed the same OSCEs had a slightly lower average score (76%) compared with plural for resident, preventive medicine residents (80%). However, this difference did not reach statistical significance (p=0.11). Conclusion Incorporating the lifestyle medicine curriculum is feasible for preventive medicine training allowing residents to improve their health behavior change discussions with patients as well as their own personal health habits. PMID:27507540

  2. Lifestyle medicine curriculum for a preventive medicine residency program: implementation and outcomes

    Directory of Open Access Journals (Sweden)

    Haq Nawaz

    2016-08-01

    Full Text Available Background: The vast majority of the healthcare problems burdening our society today are caused by disease-promoting lifestyles (e.g., physical inactivity and unhealthy eating. Physicians report poor training and lack of confidence in counseling patients on lifestyle changes. Objective: To evaluate a new curriculum and rotation in lifestyle medicine for preventive medicine residents. Methods: Training included didactics (six sessions/year, distance learning, educational conferences, and newly developed lifestyle medicine rotations at the Institute of Lifestyle Medicine, the Yale-Griffin Prevention Research Center, and the Integrative Medicine Center. We used a number of tools to assess residents’ progress including Objective Structured Clinical Examinations (OSCEs, self-assessments, and logs of personal health habits. Results: A total of 20 residents participated in the lifestyle medicine training between 2010 and 2013. There was a 15% increase in residents’ discussions of lifestyle issues with their patients based on their baseline and follow-up surveys. The performance of preventive medicine residents on OSCEs increased each year they were in the program (average OSCE score: PGY1 73%, PGY2 83%, PGY3 87%, and PGY4 91%, p=0.01. Our internal medicine and preliminary residents served as a control, since they did participate in didactics but not in lifestyle medicine rotations. Internal medicine and preliminary residents who completed the same OSCEs had a slightly lower average score (76% compared with plural for resident, preventive medicine residents (80%. However, this difference did not reach statistical significance (p=0.11. Conclusion: Incorporating the lifestyle medicine curriculum is feasible for preventive medicine training allowing residents to improve their health behavior change discussions with patients as well as their own personal health habits.

  3. Training in childhood obesity management in the United States: a survey of pediatric, internal medicine-pediatrics and family medicine residency program directors

    Directory of Open Access Journals (Sweden)

    Rhodes Erinn T

    2010-02-01

    Full Text Available Abstract Background Information about the availability and effectiveness of childhood obesity training during residency is limited. Methods We surveyed residency program directors from pediatric, internal medicine-pediatrics (IM-Peds, and family medicine residency programs between September 2007 and January 2008 about childhood obesity training offered in their programs. Results The response rate was 42.2% (299/709 and ranged by specialty from 40.1% to 45.4%. Overall, 52.5% of respondents felt that childhood obesity training in residency was extremely important, and the majority of programs offered training in aspects of childhood obesity management including prevention (N = 240, 80.3%, diagnosis (N = 282, 94.3%, diagnosis of complications (N = 249, 83.3%, and treatment (N = 242, 80.9%. However, only 18.1% (N = 54 of programs had a formal childhood obesity curriculum with variability across specialties. Specifically, 35.5% of IM-Peds programs had a formal curriculum compared to only 22.6% of pediatric and 13.9% of family medicine programs (p Conclusions While most residents receive training in aspects of childhood obesity management, deficits may exist in training quality with a minority of programs offering a formal childhood obesity curriculum. Given the high prevalence of childhood obesity, a greater emphasis should be placed on development and use of effective training strategies suitable for all specialties training physicians to care for children.

  4. Combined residency training in emergency medicine and internal medicine: an update on career outcomes and job satisfaction.

    Science.gov (United States)

    Kessler, Chad S; Stallings, Leonard A; Gonzalez, Andrew A; Templeman, Todd A

    2009-09-01

    This study was designed to provide an update on the career outcomes and experiences of graduates of combined emergency medicine-internal medicine (EM-IM) residency programs. The graduates of the American Board of Emergency Medicine (ABEM) and American Board of Internal Medicine (ABIM)-accredited EM-IM residencies from 1998 to 2008 were contacted and asked to complete a survey concerning demographics, board certification, fellowships completed, practice setting, academic affiliation, and perceptions about EM-IM training and careers. There were 127 respondents of a possible 163 total graduates for a response rate of 78%. Seventy graduates (55%) practice EM only, 47 graduates (37%) practice both EM and IM, and nine graduates (7%) practice IM or an IM subspecialty only. Thirty-one graduates (24%) pursued formal fellowship training in either EM or IM. Graduates spend the majority of their time practicing clinical EM in an urban (72%) and academic (60%) environment. Eighty-seven graduates (69%) spend at least 10% of their time in an academic setting. Most graduates (64%) believe it practical to practice both EM and IM. A total of 112 graduates (88%) would complete EM-IM training again. Dual training in EM-IM affords a great deal of career opportunities, particularly in academics and clinical practice, in a number of environments. Graduates hold their training in high esteem and would do it again if given the opportunity.

  5. How Prospective Physical Medicine and Rehabilitation Trainees Rank Residency Training Programs.

    Science.gov (United States)

    Auriemma, Michael J; Whitehair, Curtis L

    2018-03-01

    Since the inception of the National Resident Matching Program, multiple studies have investigated the factors applicants consider important to ranking prospective residency programs. However, only 2 previous studies focused on prospective physical medicine and rehabilitation (PM&R) trainees, and the most recent of these studies was published in 1993. It is unknown whether these previous studies are reflective of current prospective PM&R residents. To assess various factors that contribute to prospective PM&R residents' decision making in choosing a residency program and compare these findings with previous studies. An anonymous, voluntary questionnaire. A single PM&R residency program. All applicants to a single PM&R residency program. All applicants to our PM&R residency program were invited to participate in a 44-item, 5-point Likert-based questionnaire. Applicants were asked to rate the importance of various factors as they related to constructing their residency rank list. Means and standard deviations were calculated for items included in the survey. A response rate of 26% was obtained, with the responses of 98 applicants (20%) ultimately analyzed. The highest rated factors included "perceived happiness of current residents," "opportunities for hands-on procedure training," "perceived camaraderie among current residents," "perceived camaraderie among faculty and current residents," "perceived quality of current residents," and "perceived work/life balance among current residents." Although male and female respondents demonstrated similar ranking preferences, an apparent difference was detected between how genders rated the importance of "whether the program projects a favorable environment for women" and "whether the program projects a favorable environment for minorities." As compared with previous PM&R applicants, current prospective trainees seem to place greater importance on skill acquisition over didactic teaching. Prospective PM&R residents highly value

  6. Recommended integrative medicine competencies for family medicine residents.

    Science.gov (United States)

    Locke, Amy B; Gordon, Andrea; Guerrera, Mary P; Gardiner, Paula; Lebensohn, Patricia

    2013-01-01

    The use of complementary and alternative medicine (CAM) and Integrative Medicine (IM) has grown steadily over the past decade. Patients seek physician guidance, yet physicians typically have limited knowledge and training. There is some coverage of IM/CAM topics in medical schools and residencies but with little coordination or consistency. In 2008, the Society of Teachers of Family Medicine (STFM) group on Integrative Medicine began the process of designing a set of competencies to educate Family Medicine residents in core concepts of IM. The goal was creation of a set of nationally recognized competencies tied to the Accreditation Council for Graduate Medical Education (ACGME) domains. These competencies were to be achievable by diverse programs, including those without significant internal resources. The group compiled existing curricula from programs around the country and distilled these competencies through multiple reviews and discussions. Simultaneously, the Integrative Medicine in Residency program run by the University of Arizona underwent a similar process. In 2009, these competencies were combined and further developed at the STFM annual meeting by a group of experts. In 2010, the STFM Board approved 19 measurable competencies, each categorized by ACGME domain, as recommended for Family Medicine residencies. Programs have implemented these competencies in various ways given individual needs and resources. This paper reviews the development of IM competencies for residency education in Family Medicine and presents those endorsed by STFM. By educating physicians in training about IM/CAM via competency-based curricula, we aim to promote comprehensive patient-centered care. © 2013 Elsevier Inc. All rights reserved.

  7. Three-year emergency medicine training program in The Netherlands: first evaluation from the residents' perspective.

    Science.gov (United States)

    Koning, Salomon Willem; Gaakeer, Menno Iskander; Veugelers, Rebekka

    2013-07-26

    The Netherlands' 3-year training in Emergency Medicine (EM) was formally approved and introduced in November 2008. To identify areas for improvement, we conducted the first evaluation of this curriculum from the residents' perspective. A questionnaire was composed on ten aspects of the curriculum. It contained multiple-choice, open and opinion questions; answers to the latter were classified using the Likert scale. The questionnaires were mailed to all enrolled residents. We mailed questionnaires to all 189 enrolled residents, and 105 responded (55.6%). Although they were satisfied with their training overall, 96.2% thought it was currently too short: 18.3% desired extension to 4 years, 76.0% to 5 and 1.9% to 6 years. Nevertheless, residents expected that they would function effectively as emergency physicians (EPs) after finishing their 3-year training program. Bedside teaching was assessed positively by 35.2%. All rotations were assessed positively, with the general practice rotation seen as contributing the least to the program. According to 43.7%, supervising EPs were available for consultation; 40.7% thought that, in a clinical capacity, the EP was sufficiently present during residents' shifts. When EPs were present, 82.5% found them to be easily accessible, and 66.6% viewed them as role models. In the Emergency Medicine Departments (EDs) with a higher number of EPs employed, residents tended to perceive better supervision and were more likely to see their EPs as role models. While residents were stimulated to do research, actual support and assistance needed to be improved. Although overall, the current training program was evaluated positively, the residents identified four areas for improvement: (1) in training hospitals, trained EPs should be present more continuously for clinical supervision; (2) bedside teaching should be improved, (3) scientific research should be facilitated more and (4) the training program should be extended.

  8. Creating Entrustable Professional Activities to Assess Internal Medicine Residents in Training: A Mixed-Methods Approach.

    Science.gov (United States)

    Taylor, David R; Park, Yoon Soo; Smith, Christopher A; Karpinski, Jolanta; Coke, William; Tekian, Ara

    2018-05-15

    Competency-based medical education has not advanced residency training as much as many observers expected. Some medical educators now advocate reorienting competency-based approaches to focus on a resident's ability to do authentic clinical work. To develop descriptions of clinical work for which internal medicine residents must gain proficiency to deliver meaningful patient care (for example, "Admit and manage a medical inpatient with a new acute problem"). A modified Delphi process involving clinical experts followed by a conference of educational experts. The Royal College of Physicians and Surgeons of Canada. In phase 1 of the project, members of the Specialty Committee for Internal Medicine participated in a modified Delphi process to identify activities in internal medicine that represent the scope of the specialty. In phase 2 of the project, 5 experts who were scholars and leaders in competency-based medical education reviewed the results. Phase 1 identified important activities, revised descriptions to improve accuracy and avoid overlap, and assigned activities to stages of training. Phase 2 compared proposed activity descriptions with published guidelines for their development and application in medical education. The project identified 29 activities that qualify as entrustable professional activities. The project also produced a detailed description of each activity and guidelines for using them to assess residents. These activities reflect the practice patterns of the developers and may not fully represent internal medicine practice in Canada. Identification of these activities is expected to facilitate modification of training and assessment programs for medical residents so that programs focus less on isolated skills and more on integrated tasks. Southeastern Ontario Academic Medical Organization Endowed Scholarship and Education Fund and Queen's University Department of Medicine Innovation Fund.

  9. Medical Student Interest in Flexible Residency Training Options.

    Science.gov (United States)

    Piotrowski, Madison; Stulberg, Debra; Egan, Mari

    2018-05-01

    Medical residents continue to experience high rates of burnout during residency training even after implementation of the 2003 Accreditation Council for Graduate Medical Education duty-hour restrictions. The purpose of this study is to determine medical student interest in flexible residency training options. Researchers developed an 11-question survey for second through fourth-year medical students. The populations surveyed included medical students who were: (1) attending the 2015 American Academy of Family Physicians National Conference, the 2015 Family Medicine Midwest Conference, and (2) enrolled at University of Chicago Pritzker School of Medicine, University of Illinois College of Medicine at Chicago, Drexel University College of Medicine, and Case Western Reserve University School of Medicine. The survey was completed by 789 medical students. Over half of medical students surveyed indicated that they would be interested in working part-time during some portion of their residency training (51%), and that access to part-time training options would increase their likelihood of applying to a particular residency program (52%). When given the option of three residency training schedules of varying lengths, 41% of male students and 60% of female students chose a 60-hour workweek, even when that meant extending the residency length by 33% and reducing their yearly salary to $39,000. There is considerable interest among medical students in access to part-time residency training options and reduced-hour residency programs. This level of interest indicates that offering flexible training options could be an effective recruitment tool for residency programs and could improve students' perception of their work-life balance during residency.

  10. Expectations of clinical teachers and faculty regarding development of the CanMEDS-Family Medicine competencies: Laval developmental benchmarks scale for family medicine residency training.

    Science.gov (United States)

    Lacasse, Miriam; Théorêt, Johanne; Tessier, Sylvie; Arsenault, Louise

    2014-01-01

    The CanMEDS-Family Medicine (CanMEDS-FM) framework defines the expected terminal enabling competencies (EC) for family medicine (FM) residency training in Canada. However, benchmarks throughout the 2-year program are not yet defined. This study aimed to identify expected time frames for achievement of the CanMEDS-FM competencies during FM residency training and create a developmental benchmarks scale for family medicine residency training. This 2011-2012 study followed a Delphi methodology. Selected faculty and clinical teachers identified, via questionnaire, the expected time of EC achievement from beginning of residency to one year in practice (0, 6, 12, […] 36 months). The 15-85th percentile intervals became the expected competency achievement interval. Content validity of the obtained benchmarks was assessed through a second Delphi round. The 1st and 2nd rounds were completed by 33 and 27 respondents, respectively. A developmental benchmarks scale was designed after the 1st round to illustrate expectations regarding achievement of each EC. The 2nd round (content validation) led to minor adjustments (1.9±2.7 months) of intervals for 44 of the 92 competencies, the others remaining unchanged. The Laval Developmental Benchmarks Scale for Family Medicine clarifies expectations regarding achievement of competencies throughout FM training. In a competency-based education system this now allows identification and management of outlying residents, both those excelling and needing remediation. Further research should focus on assessment of the scale reliability after pilot implementation in family medicine clinical teaching units at Laval University, and corroborate the established timeline in other sites.

  11. Motherhood during residency training: challenges and strategies.

    Science.gov (United States)

    Walsh, Allyn; Gold, Michelle; Jensen, Phyllis; Jedrzkiewicz, Michelle

    2005-07-01

    To determine what factors enable or impede women in a Canadian family medicine residency program from combining motherhood with residency training. To determine how policies can support these women, given that in recent decades the number of female family medicine residents has increased. Qualitative study using in-person interviews. McMaster University Family Medicine Residency Program. Twenty-one of 27 family medicine residents taking maternity leave between 1994 and 1999. Semistructured interviews. The research team reviewed transcripts of audiotaped interviews for emerging themes; consensus was reached on content and meaning. NVIVO software was used for data analysis. Long hours, unpredictable work demands, guilt because absences from work increase workload for colleagues, and residents' high expectations of themselves cause pregnant residents severe stress. This stress continues upon return to work; finding adequate child care is an added stress. Residents report receiving less support from colleagues and supervisors upon return to work; they associate this with no longer being visibly pregnant. Physically demanding training rotations put additional strain on pregnant residents and those newly returned to work. Flexibility in scheduling rotations can help accommodate needs at home. Providing breaks, privacy, and refrigerators at work can help maintain breastfeeding. Allowing residents to remain involved in academic and clinical work during maternity leave helps maintain clinical skills, build new knowledge, and promote peer support. Pregnancy during residency training is common and becoming more common. Training programs can successfully enhance the experience of motherhood during residency by providing flexibility at work to facilitate a healthy balance among the competing demands of family, work, and student life.

  12. Common Factors Among Family Medicine Residents Who Encounter Difficulty.

    Science.gov (United States)

    Binczyk, Natalia M; Babenko, Oksana; Schipper, Shirley; Ross, Shelley

    2018-04-01

    Residents in difficulty are costly to programs in both time and resources, and encountering difficulty can be emotionally harmful to residents. Approximately 10% of residents will encounter difficulty at some point in training. While there have been several studies looking at common factors among residents who encounter difficulty, some of the findings are inconsistent. The objective of this study was to determine whether there are common factors among the residents who encounter difficulty during training in a large Canadian family medicine residency program. Secondary data analysis was performed on archived resident files from a Canadian family medicine residency program. Residents who commenced an urban family medicine residency program between the years of 2006 and 2014 were included in the study. Five hundred nine family medicine residents were included in data analysis. Residents older than 30 years were 2.33 times (95% CI: 1.27-4.26) more likely to encounter difficulty than residents aged 30 years or younger. Nontransfer residents were 8.85 times (95% CI: 1.17-66.67) more likely to encounter difficulty than transfer residents. The effects of sex, training site, international medical graduate status, and rotation order on the likelihood of encountering difficulty were nonsignificant. Older and nontransfer residents may be facing unique circumstances and may benefit from additional support from the program.

  13. Residents' views about family medicine specialty education in Turkey

    Directory of Open Access Journals (Sweden)

    Uzuner Arzu

    2010-04-01

    Full Text Available Abstract Background Residents are one of the key stakeholders of specialty training. The Turkish Board of Family Medicine wanted to pursue a realistic and structured approach in the design of the specialty training programme. This approach required the development of a needs-based core curriculum built on evidence obtained from residents about their needs for specialty training and their needs in the current infrastructure. The aim of this study was to obtain evidence on residents' opinions and views about Family Medicine specialty training. Methods This is a descriptive, cross-sectional study. The board prepared a questionnaire to investigate residents' views about some aspects of the education programme such as duration and content, to assess the residents' learning needs as well as their need for a training infrastructure. The questionnaire was distributed to the Family Medicine Departments (n = 27 and to the coordinators of Family Medicine residency programmes in state hospitals (n = 11 by e-mail and by personal contact. Results A total of 191 questionnaires were returned. The female/male ratio was 58.6%/41.4%. Nine state hospitals and 10 university departments participated in the study. The response rate was 29%. Forty-five percent of the participants proposed over three years for the residency duration with either extensions of the standard rotation periods in pediatrics and internal medicine or reductions in general surgery. Residents expressed the need for extra rotations (dermatology 61.8%; otolaryngology 58.6%; radiology 52.4%. Fifty-nine percent of the residents deemed a rotation in a private primary care centre necessary, 62.8% in a state primary care centre with a proposed median duration of three months. Forty-seven percent of the participants advocated subspecialties for Family Medicine, especially geriatrics. The residents were open to new educational methods such as debates, training with models, workshops and e

  14. A 15-year review of the Stanford Internal Medicine Residency Program: predictors of resident satisfaction and dissatisfaction

    Directory of Open Access Journals (Sweden)

    Kahn JS

    2017-08-01

    Full Text Available James S Kahn,1–3 Ronald M Witteles,3,4 Kenneth W Mahaffey,3–5 Sumbul A Desai,2,3 Errol Ozdalga,2,3 Paul A Heidenreich1,3 1Veterans Affairs Palo Alto Health Care System, Palo Alto, 2Division of Primary Care and Population Health, 3Department of Medicine, 4Division of Cardiovascular Medicine, 5Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford, CA, USA Introduction: Satisfaction with training and with educational experiences represents important internal medicine (IM programmatic goals. Graduates from IM residency programs are uniquely poised to provide insights into their educational and training experiences and to assess whether these experiences were satisfactory and relevant to their current employment. Methods: We surveyed former IM residents from the training program held during the years 2000–2015 at the Department of Medicine, Stanford University. The first part of the survey reviewed the IM residency program and the second part sought identifying data regarding gender, race, ethnicity, work, relationships, and financial matters. The primary outcome was satisfaction with the residency experience. Results: Of the 405 individuals who completed the Stanford IM residency program in the study period, we identified 384 (95% former residents with a known email address. Two hundred and one (52% former residents responded to the first part and 185 (48% answered both the parts of the survey. The mean age of the respondents was 36.9 years; 44% were female and the mean time from IM residency was 6.1 (±4.3 years. Fifty-eight percent reported extreme satisfaction with their IM residency experience. Predictors associated with being less than extremely satisfied included insufficient outpatient experience, insufficient international experience, insufficient clinical research experience, and insufficient time spent with family and peers. Conclusion: The residents expressed an overall high satisfaction rate with

  15. The Cost of Family Medicine Residency Training: Impacts of Federal and State Funding.

    Science.gov (United States)

    Pauwels, Judith; Weidner, Amanda

    2018-02-01

    Numerous organizations are calling for the expansion of graduate medical education (GME) positions nationally. Developing new residency programs and expanding existing programs can only happen if financial resources are available to pay for the expenses of training beyond what can be generated in direct clinical income by the residents and faculty in the program. The goal of this study was to evaluate trended data regarding the finances of family medicine residency programs to identify what financial resources are needed to sustain graduate medical education programs. A group of family medicine residency programs have shared their financial data since 2002 through a biennial survey of program revenues, expenses, and staffing. Data sets over 12 years were collected and analyzed, and results compared to analyze trends. Overall expenses increased 70.4% during this period. Centers for Medicare and Medicaid Services (CMS) GME revenue per resident increased by 15.7% for those programs receiving these monies. Overall, total revenue per resident, including clinical revenues, state funding, and any other revenue stream, increased 44.5% from 2006 to 2016. The median cost per resident among these programs, excluding federal GME funds, is currently $179,353; this amount has increased over the 12 years by 93.7%. For this study group of family medicine programs, data suggests a cost per resident per year, excluding federal and state GME funding streams, of about $180,000. This excess expense compared to revenue must be met by other agencies, whether from CMS, the Health Resources and Services Administration (HRSA), state expenditures or other sources, through stable long-term commitments to these funding mechanisms to ensure program viability for these essential family medicine programs in the future.

  16. Whither the Pulmonary Ward Attending? Preserving Subspecialty Exposure in United States Internal Medicine Residency Training.

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    Santhosh, Lekshmi; Babik, Jennifer; Looney, Mark R; Hollander, Harry

    2017-04-01

    Twenty years ago, the term "hospitalist" was coined at the University of California-San Francisco (San Francisco, CA), heralding a new specialty focused on the care of inpatients. There are now more than 50,000 hospitalists practicing in the United States. At many academic medical centers, hospitalists are largely replacing subspecialists as attendings on the inpatient medicine wards. At University of California-San Francisco, this has been accompanied by declining percentages of residency graduates who enter subspecialty training in internal medicine. The decline in subspecialty medicine interest can be attributed to many factors, including differences in compensation, decreased subspecialist exposure, and a changing research funding landscape. Although there has not been systematic documentation of this trend in pulmonary and critical care medicine, we have noted previously pulmonary and critical care-bound trainees switching to hospital medicine instead. With our broad, multiorgan system perspective, pulmonary and critical care faculty should embrace teaching general medicine. Residency programs have instituted creative solutions to encourage more internal medicine residents to pursue careers in subspecialty medicine. Some solutions include creating rotations that promote more contact with subspecialists and physician-scientists, creating clinician-educator tracks within fellowship programs, and appointing subspecialists to internal medicine residency leadership positions. We need more rigorous research to track the trends and implications of the generalist-specialist balance of inpatient ward teams on resident career choices, and learn what interventions affect those choices.

  17. Palliative Care Exposure in Internal Medicine Residency Education: A Survey of ACGME Internal Medicine Program Directors.

    Science.gov (United States)

    Edwards, Asher; Nam, Samuel

    2018-01-01

    As the baby boomer generation ages, the need for palliative care services will be paramount and yet training for palliative care physicians is currently inadequate to meet the current palliative care needs. Nonspecialty-trained physicians will need to supplement the gap between supply and demand. Yet, no uniform guidelines exist for the training of internal medicine residents in palliative care. To our knowledge, no systematic study has been performed to evaluate how internal medicine residencies currently integrate palliative care into their training. In this study, we surveyed 338 Accreditation Council for Graduate Medical Education-accredited internal medicine program directors. We queried how palliative care was integrated into their training programs. The vast majority of respondents felt that palliative care training was "very important" (87.5%) and 75.9% of respondents offered some kind of palliative care rotation, often with a multidisciplinary approach. Moving forward, we are hopeful that the data provided from our survey will act as a launching point for more formal investigations into palliative care education for internal medicine residents. Concurrently, policy makers should aid in palliative care instruction by formalizing required palliative care training for internal medicine residents.

  18. Hospitalist career decisions among internal medicine residents.

    Science.gov (United States)

    Ratelle, John T; Dupras, Denise M; Alguire, Patrick; Masters, Philip; Weissman, Arlene; West, Colin P

    2014-07-01

    Hospital medicine is a rapidly growing field of internal medicine. However, little is known about internal medicine residents' decisions to pursue careers in hospital medicine (HM). To identify which internal medicine residents choose a career in HM, and describe changes in this career choice over the course of their residency education. Observational cohort using data collected from the annual Internal Medicine In-Training Examination (IM-ITE) survey. 16,781 postgraduate year 3 (PGY-3) North American internal medicine residents who completed the annual IM-ITE survey in 2009-2011, 9,501 of whom completed the survey in all 3 years of residency. Self-reported career plans for individual residents during their postgraduate year 1 (PGY-1), postgraduate year 2 (PGY-2) and PGY-3. Of the 16,781 graduating PGY-3 residents, 1,552 (9.3 %) reported HM as their ultimate career choice. Of the 951 PGY-3 residents planning a HM career among the 9,501 residents responding in all 3 years, 128 (13.5 %) originally made this decision in PGY-1, 192 (20.2 %) in PGY-2, and 631 (66.4 %) in PGY-3. Only 87 (9.1 %) of these 951 residents maintained a career decision of HM during all three years of residency education. Hospital medicine is a reported career choice for an important proportion of graduating internal medicine residents. However, the majority of residents do not finalize this decision until their final year.

  19. Associations between quality indicators of internal medicine residency training programs

    Science.gov (United States)

    2011-01-01

    Background Several residency program characteristics have been suggested as measures of program quality, but associations between these measures are unknown. We set out to determine associations between these potential measures of program quality. Methods Survey of internal medicine residency programs that shared an online ambulatory curriculum on hospital type, faculty size, number of trainees, proportion of international medical graduate (IMG) trainees, Internal Medicine In-Training Examination (IM-ITE) scores, three-year American Board of Internal Medicine Certifying Examination (ABIM-CE) first-try pass rates, Residency Review Committee-Internal Medicine (RRC-IM) certification length, program director clinical duties, and use of pharmaceutical funding to support education. Associations assessed using Chi-square, Spearman rank correlation, univariate and multivariable linear regression. Results Fifty one of 67 programs responded (response rate 76.1%), including 29 (56.9%) community teaching and 17 (33.3%) university hospitals, with a mean of 68 trainees and 101 faculty. Forty four percent of trainees were IMGs. The average post-graduate year (PGY)-2 IM-ITE raw score was 63.1, which was 66.8 for PGY3s. Average 3-year ABIM-CE pass rate was 95.8%; average RRC-IM certification was 4.3 years. ABIM-CE results, IM-ITE results, and length of RRC-IM certification were strongly associated with each other (p ITE scores were higher in programs with more IMGs and in programs that accepted pharmaceutical support (p < 0.05). RRC-IM certification was shorter in programs with higher numbers of IMGs. In multivariable analysis, a higher proportion of IMGs was associated with 1.17 years shorter RRC accreditation. Conclusions Associations between quality indicators are complex, but suggest that the presence of IMGs is associated with better performance on standardized tests but decreased duration of RRC-IM certification. PMID:21651768

  20. Medicine in the 21st century: recommended essential geriatrics competencies for internal medicine and family medicine residents.

    Science.gov (United States)

    Williams, Brent C; Warshaw, Gregg; Fabiny, Anne Rebecca; Lundebjerg Mpa, Nancy; Medina-Walpole, Annette; Sauvigne, Karen; Schwartzberg, Joanne G; Leipzig, Rosanne M

    2010-09-01

    Physician workforce projections by the Institute of Medicine require enhanced training in geriatrics for all primary care and subspecialty physicians. Defining essential geriatrics competencies for internal medicine and family medicine residents would improve training for primary care and subspecialty physicians. The objectives of this study were to (1) define essential geriatrics competencies common to internal medicine and family medicine residents that build on established national geriatrics competencies for medical students, are feasible within current residency programs, are assessable, and address the Accreditation Council for Graduate Medical Education competencies; and (2) involve key stakeholder organizations in their development and implementation. Initial candidate competencies were defined through small group meetings and a survey of more than 100 experts, followed by detailed item review by 26 program directors and residency clinical educators from key professional organizations. Throughout, an 8-member working group made revisions to maintain consistency and compatibility among the competencies. Support and participation by key stakeholder organizations were secured throughout the project. The process identified 26 competencies in 7 domains: Medication Management; Cognitive, Affective, and Behavioral Health; Complex or Chronic Illness(es) in Older Adults; Palliative and End-of-Life Care; Hospital Patient Safety; Transitions of Care; and Ambulatory Care. The competencies map directly onto the medical student geriatric competencies and the 6 Accreditation Council for Graduate Medical Education Competencies. Through a consensus-building process that included leadership and members of key stakeholder organizations, a concise set of essential geriatrics competencies for internal medicine and family medicine residencies has been developed. These competencies are well aligned with concerns for residency training raised in a recent Medicare Payment Advisory

  1. Point-of-care ultrasonography as a training milestone for internal medicine residents: the time is now.

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    Sabath, Bruce F; Singh, Gurkeerat

    2016-01-01

    Point-of-care (POC) ultrasonography is considered fundamental in emergency medicine training and recently has become a milestone in critical care fellowship programs as well. Currently, there is no such standard requirement for internal medicine residency programs in the United States. We present a new case and briefly review another case at our institution - a community hospital - in which internal medicine house staff trained in ultrasonography were able to uncover unexpected and critical diagnoses that significantly changed patient care and outcomes. We also review the growing evidence of the application of ultrasound in the diagnosis of a myriad of conditions encountered in general internal medicine as well as the mounting data on the ability of internal medicine residents to apply this technology accurately at the bedside. We advocate that the literature has sufficiently established the role of POC ultrasonography in general internal medicine that there should no longer be any delay in giving this an official place in the development of internal medicine trainees. This may be particularly useful in the community hospital setting where 24-h echocardiography or other sonography may not be readily available.

  2. Extended family medicine training

    Science.gov (United States)

    Slade, Steve; Ross, Shelley; Lawrence, Kathrine; Archibald, Douglas; Mackay, Maria Palacios; Oandasan, Ivy F.

    2016-01-01

    Abstract Objective To examine trends in family medicine training at a time when substantial pedagogic change is under way, focusing on factors that relate to extended family medicine training. Design Aggregate-level secondary data analysis based on the Canadian Post-MD Education Registry. Setting Canada. Participants All Canadian citizens and permanent residents who were registered in postgraduate family medicine training programs within Canadian faculties of medicine from 1995 to 2013. Main outcome measures Number and proportion of family medicine residents exiting 2-year and extended (third-year and above) family medicine training programs, as well as the types and numbers of extended training programs offered in 2015. Results The proportion of family medicine trainees pursuing extended training almost doubled during the study period, going from 10.9% in 1995 to 21.1% in 2013. Men and Canadian medical graduates were more likely to take extended family medicine training. Among the 5 most recent family medicine exit cohorts (from 2009 to 2013), 25.9% of men completed extended training programs compared with 18.3% of women, and 23.1% of Canadian medical graduates completed extended training compared with 13.6% of international medical graduates. Family medicine programs vary substantially with respect to the proportion of their trainees who undertake extended training, ranging from a low of 12.3% to a high of 35.1% among trainees exiting from 2011 to 2013. Conclusion New initiatives, such as the Triple C Competency-based Curriculum, CanMEDS–Family Medicine, and Certificates of Added Competence, have emerged as part of family medicine education and credentialing. In acknowledgment of the potential effect of these initiatives, it is important that future research examine how pedagogic change and, in particular, extended training shapes the care family physicians offer their patients. As part of that research it will be important to measure the breadth and uptake of

  3. Improving family medicine resident training in dementia care: an experiential learning opportunity in Primary Care Collaborative Memory Clinics.

    Science.gov (United States)

    Lee, Linda; Weston, W Wayne; Hillier, Loretta; Archibald, Douglas; Lee, Joseph

    2018-06-21

    Family physicians often find themselves inadequately prepared to manage dementia. This article describes the curriculum for a resident training intervention in Primary Care Collaborative Memory Clinics (PCCMC), outlines its underlying educational principles, and examines its impact on residents' ability to provide dementia care. PCCMCs are family physician-led interprofessional clinic teams that provide evidence-informed comprehensive assessment and management of memory concerns. Within PCCMCs residents learn to apply a structured approach to assessment, diagnosis, and management; training consists of a tutorial covering various topics related to dementia followed by work-based learning within the clinic. Significantly more residents who trained in PCCMCs (sample = 98), as compared to those in usual training programs (sample = 35), reported positive changes in knowledge, ability, and confidence in ability to assess and manage memory problems. The PCCMC training intervention for family medicine residents provides a significant opportunity for residents to learn about best clinical practices and interprofessional care needed for optimal dementia care integrated within primary care practice.

  4. The relationship between faculty performance assessment and results on the in-training examination for residents in an emergency medicine training program.

    Science.gov (United States)

    Ryan, James G; Barlas, David; Pollack, Simcha

    2013-12-01

    Medical knowledge (MK) in residents is commonly assessed by the in-training examination (ITE) and faculty evaluations of resident performance. We assessed the reliability of clinical evaluations of residents by faculty and the relationship between faculty assessments of resident performance and ITE scores. We conducted a cross-sectional, observational study at an academic emergency department with a postgraduate year (PGY)-1 to PGY-3 emergency medicine residency program, comparing summative, quarterly, faculty evaluation data for MK and overall clinical competency (OC) with annual ITE scores, accounting for PGY level. We also assessed the reliability of faculty evaluations using a random effects, intraclass correlation analysis. We analyzed data for 59 emergency medicine residents during a 6-year period. Faculty evaluations of MK and OC were highly reliable (κ  =  0.99) and remained reliable after stratification by year of training (mean κ  =  0.68-0.84). Assessments of resident performance (MK and OC) and the ITE increased with PGY level. The MK and OC results had high correlations with PGY level, and ITE scores correlated moderately with PGY. The OC and MK results had a moderate correlation with ITE score. When residents were grouped by PGY level, there was no significant correlation between MK as assessed by the faculty and the ITE score. Resident clinical performance and ITE scores both increase with resident PGY level, but ITE scores do not predict resident clinical performance compared with peers at their PGY level.

  5. Applying Expectancy Theory to residency training: proposing opportunities to understand resident motivation and enhance residency training.

    Science.gov (United States)

    Shweiki, Ehyal; Martin, Niels D; Beekley, Alec C; Jenoff, Jay S; Koenig, George J; Kaulback, Kris R; Lindenbaum, Gary A; Patel, Pankaj H; Rosen, Matthew M; Weinstein, Michael S; Zubair, Muhammad H; Cohen, Murray J

    2015-01-01

    Medical resident education in the United States has been a matter of national priority for decades, exemplified initially through the Liaison Committee for Graduate Medical Education and then superseded by the Accreditation Council for Graduate Medical Education. A recent Special Report in the New England Journal of Medicine, however, has described resident educational programs to date as prescriptive, noting an absence of innovation in education. Current aims of contemporary medical resident education are thus being directed at ensuring quality in learning as well as in patient care. Achievement and work-motivation theories attempt to explain people's choice, performance, and persistence in tasks. Expectancy Theory as one such theory was reviewed in detail, appearing particularly applicable to surgical residency training. Correlations between Expectancy Theory as a work-motivation theory and residency education were explored. Understanding achievement and work-motivation theories affords an opportunity to gain insight into resident motivation in training. The application of Expectancy Theory in particular provides an innovative perspective into residency education. Afforded are opportunities to promote the development of programmatic methods facilitating surgical resident motivation in education.

  6. Applying Expectancy Theory to residency training: proposing opportunities to understand resident motivation and enhance residency training

    Directory of Open Access Journals (Sweden)

    Shweiki E

    2015-04-01

    Full Text Available Ehyal Shweiki,1 Niels D Martin,2 Alec C Beekley,1 Jay S Jenoff,1 George J Koenig,1 Kris R Kaulback,1 Gary A Lindenbaum,1 Pankaj H Patel,1 Matthew M Rosen,1 Michael S Weinstein,1 Muhammad H Zubair,2 Murray J Cohen1 1Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA; 2Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA Abstract: Medical resident education in the United States has been a matter of national priority for decades, exemplified initially through the Liaison Committee for Graduate Medical Education and then superseded by the Accreditation Council for Graduate Medical Education. A recent Special Report in the New England Journal of Medicine, however, has described resident educational programs to date as prescriptive, noting an absence of innovation in education. Current aims of contemporary medical resident education are thus being directed at ensuring quality in learning as well as in patient care. Achievement and work-motivation theories attempt to explain people's choice, performance, and persistence in tasks. Expectancy Theory as one such theory was reviewed in detail, appearing particularly applicable to surgical residency training. Correlations between Expectancy Theory as a work-motivation theory and residency education were explored. Understanding achievement and work-motivation theories affords an opportunity to gain insight into resident motivation in training. The application of Expectancy Theory in particular provides an innovative perspective into residency education. Afforded are opportunities to promote the development of programmatic methods facilitating surgical resident motivation in education. Keywords: learning, education, achievement

  7. [The Computer Book of the Internal Medicine resident: validity and reliability of a questionnaire for self-assessment of competences in internal medicine residents].

    Science.gov (United States)

    Oristrell, J; Casanovas, A; Jordana, R; Comet, R; Gil, M; Oliva, J C

    2012-12-01

    There are no simple and validated instruments for evaluating the training of specialists. To analyze the reliability and validity of a computerized self-assessment method to quantify the acquisition of medical competences during the Internal Medicine residency program. All residents of our department participated in the study during a period of 28 months. Twenty-two questionnaires specific for each rotation (the Computer-Book of the Internal Medicine Resident) were constructed with items (questions) corresponding to three competence domains: clinical skills competence, communication skills and teamwork. Reliability was analyzed by measuring the internal consistency of items in each competence domain using Cronbach's alpha index. Validation was performed by comparing mean scores in each competence domain between senior and junior residents. Cut-off levels of competence scores were established in order to identify the strengths and weaknesses of our training program. Finally, self-assessment values were correlated with the evaluations of the medical staff. There was a high internal consistency of the items of clinical skills competences, communication skills and teamwork. Higher scores of clinical skills competence and communication skills, but not in those of teamwork were observed in senior residents than in junior residents. The Computer-Book of the Internal Medicine Resident identified the strengths and weaknesses of our training program. We did not observe any correlation between the results of the self- evaluations and the evaluations made by staff physicians. The items of Computer-Book of the Internal Medicine Resident showed high internal consistency and made it possible to measure the acquisition of medical competences in a team of Internal Medicine residents. This self-assessment method should be complemented with other evaluation methods in order to assess the acquisition of medical competences by an individual resident. Copyright © 2012 Elsevier Espa

  8. Can we predict final outcome of internal medicine residents with in-training evaluation.

    Science.gov (United States)

    Chierakul, Nitipatana; Pongprasobchai, Supot; Boonyapisit, Kanokwan; Chinthammitr, Yingyong; Pithukpakorn, Manop; Maneesai, Adisak; Srivijitkamol, Apiradee; Koomanachai, Pornpan; Koolvisoot, Ajchara; Tanwandee, Tawesak; Shayakul, Chairat; Kachintorn, Udom

    2011-02-01

    To assess the predictive value of in-training evaluation for determining future success in the internal medicine board certifying examination. Ninety-seven internal medicine residents from Faculty of Medicine Siriraj Hospital who undertake the Thai Board examination during the academic year 2006-2008 were enrolled. Correlation between the scores during internal medicine rotation and final scores in board examination were then examined. Significant positive linear correlation was found between scores from both written and clinical parts of board certifying examination and scores from the first-year summative written and clinical examinations and also the second-year formative written examination (r = 0.43-0.68, p evaluation by attending staffs was less well correlated (r = 0.29-0.36) and the evaluation by nurses or medical students demonstrated inverse relationship (r = -0.2, p = 0.27 and r = -0.13, p = 0.48). Some methods of in-training evaluation can predict successful outcome of board certifying examination. Multisource assessments cannot well extrapolate some aspects of professional competences and qualities.

  9. Implementation and assessment of a training course for residents in neonatology and pediatric emergency medicine.

    Science.gov (United States)

    Brossier, D; Bellot, A; Villedieu, F; Fazilleau, L; Brouard, J; Guillois, B

    2017-05-01

    Residents must balance patient care and the ongoing acquisition of medical knowledge. With increasing clinical responsibilities and patient overload, medical training is often left aside. In 2010, we designed and implemented a training course in neonatology and pediatric emergency medicine for residents in pediatrics, in order to improve their medical education. The course was made of didactic sessions and several simulation-based seminars for each year of residency. We conducted this study to assess the impact of our program on residents' satisfaction and self-assessed clinical skills. A survey was conducted at the end of each seminar. The students were asked to complete a form on a five-point rating scale to evaluate the courses and their impact on their satisfaction and self-assessed clinical skills, following the French National Health Institute's adapted Kirkpatrick model. Sixty-four (84%) of the 76 residents who attended the courses completed the form. The mean satisfaction score for the entire course was 4.78±0.42. Over 80% of the students felt that their clinical skills had improved. Medical education is an important part of residency training. Our training course responded to the perceived needs of the students with consistently satisfactory evaluations. Before the evaluation of the impact of the course on patient care, further studies are needed to assess the acquisition of knowledge and skills through objective evaluations. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  10. Associations between subspecialty fellowship interest and knowledge of internal medicine: A hypothesis-generating study of internal medicine residents

    Science.gov (United States)

    2011-01-01

    Background Little is known about whether and how medical knowledge relates to interest in subspecialty fellowship training. The purpose of this study was to examine the relationships between residents' interest in subspecialty fellowship training and their knowledge of internal medicine (IM). Methods A questionnaire was emailed to 48 categorical postgraduate-year (PGY) two and three residents at a New York university-affiliated IM residency program in 2007 using the Survey Monkey online survey instrument. Overall and content area-specific percentile scores from the IM in-training examination (IM-ITE) for the same year was used to determine objective knowledge. Results Forty-five of 48 residents (response rate was 93.8%) completed the survey. Twenty-two (49%) were PG2 residents and 23(51%) were PGY3 residents. Sixty percent of respondents were male. Six (13%) residents were graduates of U.S. medical schools. Eight (18%) reported formal clinical training prior to starting internal medicine residency in the U.S. Of this latter group, 6 (75%) had training in IM and 6 (75) % reported a training length of 3 years or less. Thirty-seven of 45 (82%) residents had a subspecialty fellowship interest. Residents with a fellowship interest had a greater mean overall objective knowledge percentile score (56.44 vs. 31.67; p = 0.04) as well as greater mean percentile scores in all content areas of IM. The adjusted mean difference was statistically significant (p internal medicine residents. PMID:21281500

  11. Correlations Between Ratings on the Resident Annual Evaluation Summary and the Internal Medicine Milestones and Association With ABIM Certification Examination Scores Among US Internal Medicine Residents, 2013-2014.

    Science.gov (United States)

    Hauer, Karen E; Vandergrift, Jonathan; Hess, Brian; Lipner, Rebecca S; Holmboe, Eric S; Hood, Sarah; Iobst, William; Hamstra, Stanley J; McDonald, Furman S

    2016-12-06

    US internal medicine residency programs are now required to rate residents using milestones. Evidence of validity of milestone ratings is needed. To compare ratings of internal medicine residents using the pre-2015 resident annual evaluation summary (RAES), a nondevelopmental rating scale, with developmental milestone ratings. Cross-sectional study of US internal medicine residency programs in the 2013-2014 academic year, including 21 284 internal medicine residents (7048 postgraduate-year 1 [PGY-1], 7233 PGY-2, and 7003 PGY-3). Program director ratings on the RAES and milestone ratings. Correlations of RAES and milestone ratings by training year; correlations of medical knowledge ratings with American Board of Internal Medicine (ABIM) certification examination scores; rating of unprofessional behavior using the 2 systems. Corresponding RAES ratings and milestone ratings showed progressively higher correlations across training years, ranging among competencies from 0.31 (95% CI, 0.29 to 0.33) to 0.35 (95% CI, 0.33 to 0.37) for PGY-1 residents to 0.43 (95% CI, 0.41 to 0.45) to 0.52 (95% CI, 0.50 to 0.54) for PGY-3 residents (all P values internal medicine residents in the 2013-2014 academic year, milestone-based ratings correlated with RAES ratings but with a greater difference across training years. Both rating systems for medical knowledge correlated with ABIM certification examination scores. Milestone ratings may better detect problems with professionalism. These preliminary findings may inform establishment of the validity of milestone-based assessment.

  12. The clinician-educator track: training internal medicine residents as clinician-educators.

    Science.gov (United States)

    Smith, C Christopher; McCormick, Ian; Huang, Grace C

    2014-06-01

    Although resident-as-teacher programs bring postgraduate trainees' teaching skills to a minimum threshold, intensive, longitudinal training is lacking for residents who wish to pursue careers in medical education. The authors describe the development, implementation, and preliminary assessment of the novel track for future clinician-educators that they introduced in the internal medicine residency program at Beth Israel Deaconess Medical Center in 2010. Categorical medical interns with a career interest in medical education apply to participate in the clinician-educator track (CET) at the midpoint of their first postgraduate year. CET residents complete a 2.5-year curriculum in which they review foundations of medical education, design and assess new curricula, and evaluate learners and programs. They apply these skills in a variety of clinical settings and receive frequent feedback from faculty and peers. All CET residents design and implement at least one medical education research project. A comprehensive evaluation plan to assess the impact of the CET on resident teaching skills, scholarly productivity, career selection, and advancement is under way. A preliminary evaluation demonstrates high satisfaction with the track among the first cohort of CET residents, who graduated in 2012. Compared with residents in the traditional resident-as-teacher program, CET residents reported higher gains in their confidence in core medical education skills. Although these preliminary data are promising, data will be collected over the next several years to explore whether the additional curricular time, faculty time, and costs and potential expansion to other institutions are justified.

  13. Women residents, women physicians and medicine's future.

    Science.gov (United States)

    Serrano, Karen

    2007-08-01

    The number of women in medicine has increased dramatically in the last few decades, and women now represent half of all incoming medical students. Yet residency training still resembles the historical model when there were few women in medicine. This article reviews the issues facing women in residency today. Data suggest that the experience of female residents is more negative than that of males. Unique challenges facing female residents include the existence of gender bias and sexual harassment, a scarcity of female mentors in leadership positions, and work/family conflicts. Further research is needed to understand the experience of female residents and to identify barriers that hinder their optimal professional and personal development. Structural and cultural changes to residency programs are needed to better accommodate the needs of female trainees.

  14. Canadian residents' perceptions of cross-cultural care training in graduate medical school.

    Science.gov (United States)

    Singh, Barinder; Banwell, Emma; Groll, Dianne

    2017-12-01

    The Royal College of Physicians and Surgeons of Canada specifies both respect for diversity as a requirement of professionalism and culturally sensitive provision of medical care. The purpose of the present study was to evaluate the perception of preparedness and attitudes of medical residents to deliver cross-cultural care. The Cross Cultural Care Survey was sent via e-mail to all Faculty of Medicine residents (approx. 450) in an academic health sciences centre. Comparisons were made between psychiatry residents, family medicine residents, and other residency groups with respect to training, preparedness, and skillfulness in delivering cross-cultural care. Seventy-three (16%) residents responded to the survey. Residents in psychiatry and family medicine reported significantly more training and formal evaluation regarding cross-cultural care than residents in other programs. However, there were no significant differences in self-reported preparedness and skillfulness. Residents in family medicine were more likely to report needing more practical experience working with diverse groups. Psychiatry residents were less likely to report inadequate cross-cultural training. While most residents reported feeling skillful and prepared to work with culturally diverse groups, they report receiving little additional instruction or formal evaluation on this topic, particularly in programs other than psychiatry and family medicine.

  15. Faculty staff-guided versus self-guided ultrasound training for internal medicine residents.

    Science.gov (United States)

    Alba, George A; Kelmenson, Daniel A; Noble, Vicki E; Murray, Alice F; Currier, Paul F

    2013-11-01

    Ultrasonography is of growing importance within internal medicine (IM), but the optimal method of training doctors to use it is uncertain. In this study, the authors provide the first objective comparison of two approaches to training IM residents in ultrasonography. In this randomised trial, a simulation-based ultrasound training curriculum was implemented during IM intern orientation at a tertiary care teaching hospital. All 72 incoming interns attended a lecture and were given access to online modules. Interns were then randomly assigned to a 4-hour faculty-guided (FG) or self-guided (SG) ultrasound training session in a simulation laboratory with both human and manikin models. Interns were asked to self-assess their competence in ultrasonography and underwent an objective structured clinical examination (OSCE) to assess their competence in basic and procedurally oriented ultrasound tasks. The primary outcome was the score on the OSCE. Faculty-guided training was superior to self-guided training based on the OSCE scores. Subjects in the FG training group achieved significantly higher OSCE scores on the two subsets of task completion (0.9-point difference, 95% confidence interval [CI] 0.27-1.54; p = 0.008) and ultrasound image quality (2.43-point difference, 95% CI 1.5-3.36; p training groups demonstrated an increase in self-assessed competence after their respective training sessions and there was little difference between the groups. Subjects rated the FG training group much more favourably than the SG training group. Both FG and SG ultrasound training curricula can improve the self-reported competence of IM interns in ultrasonography. However, FG training was superior to SG training in both skills acquisition and intern preference. Incorporating mandatory ultrasound training into IM residencies can address the perceived need for ultrasound training, improve confidence and procedural skills, and may enhance patient safety. However, the optimal training method

  16. Associations between subspecialty fellowship interest and knowledge of internal medicine: A hypothesis-generating study of internal medicine residents

    Directory of Open Access Journals (Sweden)

    Haidet Paul

    2011-01-01

    Full Text Available Abstract Background Little is known about whether and how medical knowledge relates to interest in subspecialty fellowship training. The purpose of this study was to examine the relationships between residents' interest in subspecialty fellowship training and their knowledge of internal medicine (IM. Methods A questionnaire was emailed to 48 categorical postgraduate-year (PGY two and three residents at a New York university-affiliated IM residency program in 2007 using the Survey Monkey online survey instrument. Overall and content area-specific percentile scores from the IM in-training examination (IM-ITE for the same year was used to determine objective knowledge. Results Forty-five of 48 residents (response rate was 93.8% completed the survey. Twenty-two (49% were PG2 residents and 23(51% were PGY3 residents. Sixty percent of respondents were male. Six (13% residents were graduates of U.S. medical schools. Eight (18% reported formal clinical training prior to starting internal medicine residency in the U.S. Of this latter group, 6 (75% had training in IM and 6 (75 % reported a training length of 3 years or less. Thirty-seven of 45 (82% residents had a subspecialty fellowship interest. Residents with a fellowship interest had a greater mean overall objective knowledge percentile score (56.44 vs. 31.67; p = 0.04 as well as greater mean percentile scores in all content areas of IM. The adjusted mean difference was statistically significant (p Conclusions More than half of surveyed residents indicated interest in pursuing a subspecialty fellowship. Fellowship interest appears positively associated with general medical knowledge in this study population. Further work is needed to explore motivation and study patterns among internal medicine residents.

  17. The cost-effectiveness of training US primary care physicians to conduct colorectal cancer screening in family medicine residency programs.

    Science.gov (United States)

    Edwardson, Nicholas; Bolin, Jane N; McClellan, David A; Nash, Philip P; Helduser, Janet W

    2016-04-01

    Demand for a wide array of colorectal cancer screening strategies continues to outpace supply. One strategy to reduce this deficit is to dramatically increase the number of primary care physicians who are trained and supportive of performing office-based colonoscopies or flexible sigmoidoscopies. This study evaluates the clinical and economic implications of training primary care physicians via family medicine residency programs to offer colorectal cancer screening services as an in-office procedure. Using previously established clinical and economic assumptions from existing literature and budget data from a local grant (2013), incremental cost-effectiveness ratios are calculated that incorporate the costs of a proposed national training program and subsequent improvements in patient compliance. Sensitivity analyses are also conducted. Baseline assumptions suggest that the intervention would produce 2394 newly trained residents who could perform 71,820 additional colonoscopies or 119,700 additional flexible sigmoidoscopies after ten years. Despite high costs associated with the national training program, incremental cost-effectiveness ratios remain well below standard willingness-to-pay thresholds under base case assumptions. Interestingly, the status quo hierarchy of preferred screening strategies is disrupted by the proposed intervention. A national overhaul of family medicine residency programs offering training for colorectal cancer screening yields satisfactory incremental cost-effectiveness ratios. However, the model places high expectations on primary care physicians to improve current compliance levels in the US. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Developing educators, investigators, and leaders during internal medicine residency: the area of distinction program.

    Science.gov (United States)

    Kohlwes, R Jeffrey; Cornett, Patricia; Dandu, Madhavi; Julian, Katherine; Vidyarthi, Arpana; Minichiello, Tracy; Shunk, Rebecca; Jain, Sharad; Harleman, Elizabeth; Ranji, Sumant; Sharpe, Brad; O'Sullivan, Patricia; Hollander, Harry

    2011-12-01

    Professional organizations have called for individualized training approaches, as well as for opportunities for resident scholarship, to ensure that internal medicine residents have sufficient knowledge and experience to make informed career choices. To address these training issues within the University of California, San Francisco, internal medicine program, we created the Areas of Distinction (AoD) program to supplement regular clinical duties with specialized curricula designed to engage residents in clinical research, global health, health equities, medical education, molecular medicine, or physician leadership. We describe our AoD program and present this initiative's evaluation data. METHODS AND PROGRAM EVALUATION: We evaluated features of our AoD program, including program enrollment, resident satisfaction, recruitment surveys, quantity of scholarly products, and the results of our resident's certifying examination scores. Finally, we described the costs of implementing and maintaining the AoDs. AoD enrollment increased from 81% to 98% during the past 5 years. Both quantitative and qualitative data demonstrated a positive effect on recruitment and improved resident satisfaction with the program, and the number and breadth of scholarly presentations have increased without an adverse effect on our board certification pass rate. The AoD system led to favorable outcomes in the domains of resident recruitment, satisfaction, scholarship, and board performance. Our intervention showed that residents can successfully obtain clinical training while engaging in specialized education beyond the bounds of core medicine training. Nurturing these interests 5 empower residents to better shape their careers by providing earlier insight into internist roles that transcend classic internal medicine training.

  19. Getting it RITE: Impact of a Dedicated Hospital Medicine Curriculum for Residents.

    Science.gov (United States)

    Lin, Doris; Shah, Chirayu; Campbell, Steffanie; Bates, Jeffrey T; Lescinskas, Erica

    2018-01-01

    The goal of this study was to improve resident confidence in inpatient care and knowledge in hospital medicine topics with a newly developed rotation and curriculum called the Resident Inpatient Training Experience. This study was a prospective observational study completed by postgraduate year-2 (PGY-2) internal medicine residents in two affiliated hospitals. Forty-six PGY-2 residents each rotated on the Resident Inpatient Training Experience service for 1 month and completed a pre- and postrotation confidential online survey. Primary outcomes included confidence in managing hospitalized patients, knowledge regarding hospital medicine topics, and interest in pursuing hospital medicine as a career. Thirty-three PGY-2 residents completed both the pre- and postrotation survey (72% response rate). After completing the rotation, the residents' confidence level (measured on a 5-point Likert scale, with 1 = strongly disagree and 5 = strongly agree) rose significantly in managing hospitalized patients, from 3.82 to 4.33 ( P = 0.003) and in leading a ward team, from 3.76 to 4.21 ( P = 0.020). Knowledge level (measured on a 5-point Likert scale with 1 = very poor and 5 = excellent) improved significantly in transitions of care, from 3.45 to 3.79 ( P = 0.023); cost-conscious care, from 3.00 to 3.42 ( P = 0.016); physician billing/coding, from 2.55 to 3.03 ( P = 0.007); hospital metrics, from 2.39 to 2.94 ( P = 0.002); and hospital reimbursement, from 2.48 to 3.09 ( P = 0.001). Interest in pursuing hospital medicine as a career also increased. Resident independence in managing patients and training in hospital medicine topics has not kept up with evolving need. Dedicated hospital medicine rotation and curriculum are effective ways to alleviate the deficiencies in resident education.

  20. Family medicine residency program directors attitudes and knowledge of family medicine CAM competencies.

    Science.gov (United States)

    Gardiner, Paula; Filippelli, Amanda C; Lebensohn, Patricia; Bonakdar, Robert

    2013-01-01

    Little is known about the incorporation of integrative medicine (IM) and complementary and alternative medicine (CAM) into family medicine residency programs. The Society for Teachers of Family Medicine (STFM) approved a set of CAM/IM competencies for family medicine residencies. We hope to evaluate whether residency programs are implementing such competencies into their curriculum using an online survey tool. We also hope to assess the knowledge and attitudes of Residency Directors (RDs) on the CAM/IM competencies. A survey was distributed by the Council of Academic Family Medicine (CAFM) Educational Research Alliance to RDs via e-mail. The survey was distributed to 431 RDs. Of those who received it, 212 responded, giving a response rate of 49.1%. Questions assessed the knowledge and attitudes of CAM/IM competencies and incorporation of CAM/IM into the residency curriculum. Forty-five percent of RDs were aware of the competencies. In terms of RD attitudes, 58% reported that CAM/IM is an important component of residents' curriculum; yet, 60% report not having specific learning objectives for CAM/IM in their residency curriculum. Among all programs, barriers to CAM/IM implementation included time in residents' schedules (77%); faculty training (75%); access to CAM experts (43%); lack of reimbursement (43%); and financial resources (29%). While many RDs are aware of the STFM CAM/IM competencies and acknowledge their role in residence education, there are many barriers that prevent residencies from implementing the STFM CAM/IM competencies. © 2013 Elsevier Inc. All rights reserved.

  1. A Model Curriculum for an Emergency Medical Services (EMS Rotation for Emergency Medicine Residents

    Directory of Open Access Journals (Sweden)

    Michael Mancera

    2018-01-01

    Full Text Available Audience: This EMS curriculum is designed for Emergency Medicine residents at all levels of training. Introduction: Emergency Medicine (EM physicians have routine interaction with Emergency Medical Services (EMS in their clinical practice. Additionally, the American College of Graduate Medical Education (ACGME mandates that all Emergency Medicine resident physicians receive specific training in the area of EMS.1 Historically, EMS training for EM residents has been conducted in the absence of a standardized didactic curriculum. Despite advancements in the area of prehospital training, there remains wide inconsistency in EMS training experiences among EM residency training programs.2 To our knowledge a standardized and reproducible EMS curriculum for EM residents does not exist. Objectives: The aim of this curriculum is to provide a robust learning experience for EM residents around prehospital care and EMS that fulfills the ACGME requirements and which can be easily replicated and implemented in a variety of EM residency training programs. Method: The educational strategies used in this curriculum include didactics, asynchronous learning through online modules and a focused reading list, experiential learning through ride-alongs, structured small group discussion, supervised medical command shifts, and mentored practice in organizing and delivering didactics to EMS providers.

  2. Otolaryngology Training for Family Practice Residents.

    Science.gov (United States)

    And Others; Rood, Stewart R.

    1980-01-01

    The faculty of the Department of Otolaryngology, University of Pittsburgh School of Medicine, has designed a rotation in the otolaryngology service, that is a basic clinical orientation to ear, nose and throat medicine, to fit the one-month block committed by the local family practice residency training program. The program is described and its…

  3. Factors Associated with Medical Knowledge Acquisition During Internal Medicine Residency

    Science.gov (United States)

    Zeger, Scott L.; Kolars, Joseph C.

    2007-01-01

    BACKGROUND Knowledge acquisition is a goal of residency and is measurable by in-training exams. Little is known about factors associated with medical knowledge acquisition. OBJECTIVE To examine associations of learning habits on medical knowledge acquisition. DESIGN, PARTICIPANTS Cohort study of all 195 residents who took the Internal Medicine In-Training Examination (IM-ITE) 421 times over 4 years while enrolled in the Internal Medicine Residency, Mayo Clinic, Rochester, MN. MEASUREMENTS Score (percent questions correct) on the IM-ITE adjusted for variables known or hypothesized to be associated with score using a random effects model. RESULTS When adjusting for demographic, training, and prior achievement variables, yearly advancement within residency was associated with an IM-ITE score increase of 5.1% per year (95%CI 4.1%, 6.2%; p international medical school graduation, −3.4% (95%CI −6.5%, −0.36%; p = .03). CONCLUSIONS Conference attendance and self-directed reading of an electronic knowledge resource had statistically and educationally significant independent associations with knowledge acquisition that were comparable to the benefit of a year in residency training. PMID:17468889

  4. Resident involvement in civilian tactical emergency medicine.

    Science.gov (United States)

    Ramirez, Mario Luis; Slovis, Corey M

    2010-07-01

    Tactical emergency medicine services (TEMS) has emerged as a specialized niche within the field of emergency medicine. With increasing demand for physician participation in civilian tactical teams, there will be efforts by residents to become involved at earlier points in their clinical training. This article discusses resident involvement with a civilian TEMS unit and provides five maxims for emergency physicians to better understand the difference between working in the emergency department or with emergency medical services vs. in a TEMS environment. Differences between TEMS and other trauma life support models, institutional and political barriers likely to be encountered by the resident, the value of preventive medicine and the role of the physician in long-term tactical operations, opportunities for subspecialty growth, and the role of operational security are all discussed in detail. Tactical emergency medicine is a specialty that utilizes the full array of the emergency physician's skill set. It is also a field that is ripe for continued expansion, but the resident looking to become involved with a team should be aware of the requirements necessary to do so and the obstacles likely to be encountered along the way. Copyright 2010 Elsevier Inc. All rights reserved.

  5. A new model for accreditation of residency programs in internal medicine.

    Science.gov (United States)

    Goroll, Allan H; Sirio, Carl; Duffy, F Daniel; LeBlond, Richard F; Alguire, Patrick; Blackwell, Thomas A; Rodak, William E; Nasca, Thomas

    2004-06-01

    A renewed emphasis on clinical competence and its assessment has grown out of public concerns about the safety, efficacy, and accountability of health care in the United States. Medical schools and residency training programs are paying increased attention to teaching and evaluating basic clinical skills, stimulated in part by these concerns and the responding initiatives of accrediting, certifying, and licensing bodies. This paper, from the Residency Review Committee for Internal Medicine of the Accreditation Council for Graduate Medical Education, proposes a new outcomes-based accreditation strategy for residency training programs in internal medicine. It shifts residency program accreditation from external audit of educational process to continuous assessment and improvement of trainee clinical competence.

  6. The State of Communication Education in Family Medicine Residencies.

    Science.gov (United States)

    Jansen, Kate L; Rosenbaum, Marcy E

    2016-06-01

    Communication skills are essential to medical training and have lasting effects on patient satisfaction and adherence rates. However, relatively little is reported in the literature identifying how communication is taught in the context of residency education. Our goal was to determine current practices in communication curricula across family medicine residency programs. Behavioral scientists and program directors in US family medicine residencies were surveyed via email and professional organization listservs. Questions included whether programs use a standardized communication model, methods used for teaching communication, hours devoted to teaching communication, as well as strengths and areas for improvement in their program. Analysis identified response frequencies and ranges complemented by analysis of narrative comments. A total of 204 programs out of 458 family medicine residency training sites responded (45%), with 48 out of 50 US states represented. The majority of respondents were behavioral scientists. Seventy-five percent of programs identified using a standard communication model; Mauksch's patient-centered observation model (34%) was most often used. Training programs generally dedicated more time to experiential teaching methods (video review, work with simulated patients, role plays, small groups, and direct observation of patient encounters) than to lectures (62% of time and 24% of time, respectively). The amount of time dedicated to communication education varied across programs (average of 25 hours per year). Respondent comments suggest that time dedicated to communication education and having a formal curriculum in place are most valued by educators. This study provides a picture of how communication skills teaching is conducted in US family medicine residency programs. These findings can provide a comparative reference and rationale for residency programs seeking to evaluate their current approaches to communication skills teaching and

  7. First-Year Residents Outperform Third-Year Residents after Simulation-Based Education in Critical Care Medicine

    Science.gov (United States)

    Singer, Benjamin D.; Corbridge, Thomas C.; Schroedl, Clara J.; Wilcox, Jane E.; Cohen, Elaine R.; McGaghie, William C.; Wayne, Diane B.

    2012-01-01

    Introduction Prior research shows that gaps exist in internal medicine residents’ critical care knowledge and skills. The purpose of this study was to compare the bedside critical care competency of first-year residents who received a simulation-based educational intervention plus clinical training to third-year residents who received clinical training alone. Methods During their first three months of residency, a group of first-year residents completed a simulation-based educational intervention. A group of traditionally-trained third-year residents who did not receive simulation-based training served as a comparison group. Both groups were evaluated using a 20-item clinical skills assessment at the bedside of a patient receiving mechanical ventilation at the end of their medical intensive care unit rotation. Scores on the skills assessment were compared between groups. Results Simulator-trained first-year residents (n=40) scored significantly higher compared to traditionally-trained third-year residents (n=27) on the bedside assessment, 91.3% (95% CI 88.2% to 94.3%) vs. 80.9% (95% CI 76.8% to 85.0%), P = simulation-based educational intervention demonstrated higher clinical competency than third-year residents who did not undergo simulation training. Critical care competency cannot be assumed after clinical ICU rotations; simulation-based curricula can help ensure residents are proficient to care for critically ill patients. PMID:23222546

  8. Teaching wound care to family medicine residents on a wound care service

    Directory of Open Access Journals (Sweden)

    Little SH

    2013-08-01

    Full Text Available Sahoko H Little,1,2 Sunil S Menawat,1,3 Michael Worzniak,1 Michael D Fetters2 1Oakwood Annapolis Family Medicine Residency, Wayne, Michigan, USA; 2University of Michigan, Department of Family Medicine, Ann Arbor, Michigan, USA; 3Ghent Family Medicine Residency, Eastern Virginia Medical School, Norfolk, Virginia, USA Abstract: Primary care physicians often care for patients with chronic wounds, and they can best serve patients if they have knowledge and proficient skills in chronic wound care, including sharp debridement. The Oakwood Annapolis Family Medicine Residency in Michigan, USA developed a Wound Care Service, incorporating wound care training during the surgical rotation. Effectiveness of the wound care training was evaluated through pre- and posttesting of residents, to assess changes in knowledge and comfort in treating chronic wounds. The results demonstrate significant improvement in residents’ knowledge and comfort in wound care. This innovation demonstrates the feasibility of educating residents in chronic wound care through hands-on experience. Keywords: wound care education, primary care, residency education, surgery rotation, curriculum development

  9. A Comparison of Surgery and Family Medicine Residents' Perceptions of Cross-Cultural Care Training of Cross-Cultural Care Training

    OpenAIRE

    Chun, Maria BJ; Jackson, David S; Lin, Susan Y; Park, Elyse R

    2010-01-01

    The need for physicians formally trained to deliver care to diverse patient populations has been widely advocated. Utilizing a validated tool, Weissman and Betancourt's Cross-Cultural Care Survey, the aim of this current study was to compare surgery and family medicine residents' perceptions of their preparedness and skillfulness to provide high quality cross-cultural care. Past research has documented differences between the two groups' reported impressions of importance and level of instruc...

  10. Perceptions, training experiences, and preferences of surgical residents toward laparoscopic simulation training: a resident survey.

    Science.gov (United States)

    Shetty, Shohan; Zevin, Boris; Grantcharov, Teodor P; Roberts, Kurt E; Duffy, Andrew J

    2014-01-01

    Simulation training for surgical residents can shorten learning curves, improve technical skills, and expedite competency. Several studies have shown that skills learned in the simulated environment are transferable to the operating room. Residency programs are trying to incorporate simulation into the resident training curriculum to supplement the hands-on experience gained in the operating room. Despite the availability and proven utility of surgical simulators and simulation laboratories, they are still widely underutilized by surgical trainees. Studies have shown that voluntary use leads to minimal participation in a training curriculum. Although there are several simulation tools, there is no clear evidence of the superiority of one tool over the other in skill acquisition. The purpose of this study was to explore resident perceptions, training experiences, and preferences regarding laparoscopic simulation training. Our goal was to profile resident participation in surgical skills simulation, recognize potential barriers to voluntary simulator use, and identify simulation tools and tasks preferred by residents. Furthermore, this study may help to inform whether mandatory/protected training time, as part of the residents' curriculum is essential to enhance participation in the simulation laboratory. A cross-sectional study on general surgery residents (postgraduate years 1-5) at Yale University School of Medicine and the University of Toronto via an online questionnaire was conducted. Overall, 67 residents completed the survey. The institutional review board approved the methods of the study. Overall, 95.5% of the participants believed that simulation training improved their laparoscopic skills. Most respondents (92.5%) perceived that skills learned during simulation training were transferrable to the operating room. Overall, 56.7% of participants agreed that proficiency in a simulation curriculum should be mandatory before operating room experience. The

  11. Procedural Headache Medicine in Neurology Residency Training: A Survey of US Program Directors.

    Science.gov (United States)

    Robbins, Matthew S; Robertson, Carrie E; Ailani, Jessica; Levin, Morris; Friedman, Deborah I; Dodick, David W

    2016-01-01

    To survey neurology residency program directors (PDs) on trainee exposure, supervision, and credentialing in procedures widely utilized in headache medicine. Clinic-based procedures have assumed a prominent role in headache therapy. Headache fellows obtain procedural competence, but reliance on fellowship-trained neurologists cannot match the population eligible for treatments. The inclusion of educational modules and mechanisms for credentialing trainees pursuing procedural competence in residency curricula at individual programs is not known. A web-based survey of US neurology residency PDs was designed by the American Headache Society (AHS) procedural special interest section in collaboration with AHS and American Academy of Neurology's Headache and Facial Pain section leadership. The survey addressed exposure, training, and credentialing in: (1) onabotulinumtoxinA (onabotA) injections, (2) extracranial peripheral nerve blocks (PNBs), and (3) trigger point injections (TPIs). Fifty-five PDs (42.6%) completed the survey. Compared to noncompleters, survey completers were more likely to feature headache fellowships at their institutions (38.2% vs 10.8%, P=0.0002). High exposure (onabotA=90.9%, PNBs=80.0%, TPIs=70.9%) usually featured hands-on patient instruction (66.2%) and lectures (55.7%). Supervised performance rates were high (onabotA=65.5%, PNBs=60.0%, TPIs=52.7%), usually in continuity clinic (60.0%) or headache elective (50.9%). Headache specialists (69.1%) or general neurology (32.7%) faculty most commonly trained residents. Formal credentialing was uncommon (16.4-18.2%), mostly by documenting supervised procedures (25.5%). Only 27.3% of programs permitted trainees to perform procedures independently. Most PDs felt procedural exposure (80.0-90.9%) and competence (50.9-56.4%) by all trainees was important. Resident exposure to procedures for headache is high, but credentialing mechanisms, while desired by most PDs, are not generally in place. Implementation

  12. The Most Common Feedback Themes in Communication Skills Training in an Internal Medicine Residency Program: Lessons from the Resident Audio-Recording Project.

    Science.gov (United States)

    Han, Heeyoung; Papireddy, Muralidhar Reddy; Hingle, Susan T; Ferguson, Jacqueline Anne; Koschmann, Timothy; Sandstrom, Steve

    2018-07-01

    Individualized structured feedback is an integral part of a resident's learning in communication skills. However, it is not clear what feedback residents receive for their communication skills development in real patient care. We will identify the most common feedback topics given to residents regarding communication skills during Internal Medicine residency training. We analyzed Resident Audio-recording Project feedback data from 2008 to 2013 by using a content analysis approach. Using open coding and an iterative categorization process, we identified 15 emerging themes for both positive and negative feedback. The most recurrent feedback topics were Patient education, Thoroughness, Organization, Questioning strategy, and Management. The residents were guided to improve their communication skills regarding Patient education, Thoroughness, Management, and Holistic exploration of patient's problem. Thoroughness and Communication intelligibility were newly identified themes that were rarely discussed in existing frameworks. Assessment rubrics serve as a lens through which we assess the adequacy of the residents' communication skills. Rather than sticking to a specific rubric, we chose to let the rubric evolve through our experience.

  13. Self vs. Other Focus: Predicting Professionalism Remediation of Emergency Medicine Residents.

    Science.gov (United States)

    Thaxton, Robert E; Jones, Woodson S; Hafferty, Fred W; April, Carolyn W; April, Michael D

    2018-01-01

    Unprofessionalism is a major reason for resident dismissal from training. Because of the high stakes involved, residents and educators alike would benefit from information predicting whether they might experience challenges related to this competency. Our objective was to correlate the outcome of professionalism-related remedial actions during residency with the predictor variable of resident response to a standardized interview question: "Why is Medicine important to you?" We conducted a professional development quality improvement (QI) initiative to improve resident education and mentorship by achieving a better understanding of each resident's reasons for valuing a career in medicine. This initiative entailed an interview administered to each resident beginning emergency medicine training at San Antonio Military Medical Center during 2006-2013. The interviews uniformly began with the standardized question "Why is Medicine important to you?" The residency program director documented a free-text summary of each response to this question, the accuracy of which was confirmed by the resident. We analyzed the text of each resident's response after a review of the QI data suggested an association between responses and professionalism actions (retrospective cohort design). Two associate investigators blinded to all interview data, remedial actions, and resident identities categorized each text response as either self-focused (e.g., "I enjoy the challenge") or other-focused (e.g., "I enjoy helping patients"). Additional de-identified data collected included demographics, and expressed personal importance of politics and religion. The primary outcome was a Clinical Competency Committee professionalism remedial action. Of 114 physicians starting residency during 2006-2013, 106 (93.0%) completed the interview. There was good inter-rater reliability in associate investigator categorization of resident responses as either self-focused or other-focused (kappa coefficient 0

  14. Predictors of Final Specialty Choice by Internal Medicine Residents

    Science.gov (United States)

    Diehl, Andrew K; Kumar, Vineeta; Gateley, Ann; Appleby, Jane L; O'Keefe, Mary E

    2006-01-01

    BACKGROUND Sociodemographic factors and personality attributes predict career decisions in medical students. Determinants of internal medicine residents' specialty choices have received little attention. OBJECTIVE To identify factors that predict the clinical practice of residents following their training. DESIGN Prospective cohort study. PARTICIPANTS Two hundred and four categorical residents from 2 university-based residency programs. MEASUREMENTS Sociodemographic and personality inventories performed during residency, and actual careers 4 to 9 years later. RESULTS International medical school graduates (IMGs) were less likely to practice general medicine than U.S. graduates (33.3% vs 70.6%, Pinternal medicine was observed among those who perceived General Internists to have lower potential incomes (69.0% vs 53.3%, P = .08). There was a trend for generalists to have lower scores on scales measuring authoritarianism, negative orientation to psychological problems, and Machiavellianism (0.05medicine, with trends apparent for higher debt (P = .05) and greater comfort caring for patients with psychological problems (P = .07). CONCLUSION Recruitment of IMGs may not increase the supply of General Internists. Prospects of lower income, even in the face of large debt, may not discourage residents from becoming generalists. If increasing generalist manpower is a goal, residencies should consider weighing applicants' personal attributes during the selection process. PMID:16836624

  15. Increasing emergency medicine residents' confidence in disaster management: use of an emergency department simulator and an expedited curriculum.

    Science.gov (United States)

    Franc, Jeffrey Michael; Nichols, Darren; Dong, Sandy L

    2012-02-01

    Disaster Medicine is an increasingly important part of medicine. Emergency Medicine residency programs have very high curriculum commitments, and adding Disaster Medicine training to this busy schedule can be difficult. Development of a short Disaster Medicine curriculum that is effective and enjoyable for the participants may be a valuable addition to Emergency Medicine residency training. A simulation-based curriculum was developed. The curriculum included four group exercises in which the participants developed a disaster plan for a simulated hospital. This was followed by a disaster simulation using the Disastermed.Ca Emergency Disaster Simulator computer software Version 3.5.2 (Disastermed.Ca, Edmonton, Alberta, Canada) and the disaster plan developed by the participants. Progress was assessed by a pre- and post-test, resident evaluations, faculty evaluation of Command and Control, and markers obtained from the Disastermed.Ca software. Twenty-five residents agreed to partake in the training curriculum. Seventeen completed the simulation. There was no statistically significant difference in pre- and post-test scores. Residents indicated that they felt the curriculum had been useful, and judged it to be preferable to a didactic curriculum. In addition, the residents' confidence in their ability to manage a disaster increased on both a personal and and a departmental level. A simulation-based model of Disaster Medicine training, requiring approximately eight hours of classroom time, was judged by Emergency Medicine residents to be a valuable component of their medical training, and increased their confidence in personal and departmental disaster management capabilities.

  16. Cost of Incremental Expansion of an Existing Family Medicine Residency Program.

    Science.gov (United States)

    Ashkin, Evan A; Newton, Warren P; Toomey, Brian; Lingley, Ronald; Page, Cristen P

    2017-07-01

    Expanding residency training programs to address shortages in the primary care workforce is challenged by the present graduate medical education (GME) environment. The Medicare funding cap on new GME positions and reductions in the Health Resources and Services Administration (HRSA) Teaching Health Center (THC) GME program require innovative solutions to support primary care residency expansion. Sparse literature exists to assist in predicting the actual cost of incremental expansion of a family medicine residency program without federal or state GME support. In 2011 a collaboration to develop a community health center (CHC) academic medical partnership (CHAMP), was formed and created a THC as a training site for expansion of an existing family medicine residency program. The cost of expansion was a critical factor as no Federal GME funding or HRSA THC GME program support was available. Initial start-up costs were supported by a federal grant and local foundations. Careful financial analysis of the expansion has provided actual costs per resident of the incremental expansion of the residencyRESULTS: The CHAMP created a new THC and expanded the residency from eight to ten residents per year. The cost of expansion was approximately $72,000 per resident per year. The cost of incremental expansion of our residency program in the CHAMP model was more than 50% less than that of the recently reported cost of training in the HRSA THC GME program.

  17. Predicting performance using background characteristics of international medical graduates in an inner-city university-affiliated Internal Medicine residency training program

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    Akhuetie Jane

    2009-07-01

    Full Text Available Abstract Background IMGs constitute about a third of the United States (US internal medicine graduates. US residency training programs face challenges in selection of IMGs with varied background features. However data on this topic is limited. We analyzed whether any pre-selection characteristics of IMG residents in our internal medicine program are associated with selected outcomes, namely competency based evaluation, examination performance and success in acquiring fellowship positions after graduation. Methods We conducted a retrospective study of 51 IMGs at our ACGME accredited teaching institution between 2004 and 2007. Background resident features namely age, gender, self-reported ethnicity, time between medical school graduation to residency (pre-hire time, USMLE step I & II clinical skills scores, pre-GME clinical experience, US externship and interest in pursuing fellowship after graduation expressed in their personal statements were noted. Data on competency-based evaluations, in-service exam scores, research presentation and publications, fellowship pursuance were collected. There were no fellowships offered in our hospital in this study period. Background features were compared between resident groups according to following outcomes: (a annual aggregate graduate PGY-level specific competency-based evaluation (CBE score above versus below the median score within our program (scoring scale of 1 – 10, (b US graduate PGY-level specific resident in-training exam (ITE score higher versus lower than the median score, and (c those who succeeded to secure a fellowship within the study period. Using appropriate statistical tests & adjusted regression analysis, odds ratio with 95% confidence intervals were calculated. Results 94% of the study sample were IMGs; median age was 35 years (Inter-Quartile range 25th – 75th percentile (IQR: 33–37 years; 43% women and 59% were Asian physicians. The median pre-hire time was 5 years (IQR: 4–7

  18. Does Research Training During Residency Promote Scholarship and Influence Career Choice? A Cross-Sectional Analysis of a 10-Year Cohort of the UCSF-PRIME Internal Medicine Residency Program.

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    Kohlwes, Jeffrey; O'Brien, Bridget; Stanley, Marion; Grant, Ross; Shunk, Rebecca; Connor, Denise; Cornett, Patricia; Hollander, Harry

    2016-01-01

    The Association of Program Directors in Internal Medicine, the Accreditation Council for Graduate Medical Education, the Alliance for Academic Internal Medicine, and the Carnegie Foundation report on medical education recommend creating individualized learning pathways during medical training so that learners can experience broader professional roles beyond patient care. Little data exist to support the success of these specialized pathways in graduate medical education. We present the 10-year experience of the Primary Care Medicine Education (PRIME) track, a clinical-outcomes research pathway for internal medicine residents at the University of California San Francisco (UCSF). We hypothesized that participation in an individualized learning track, PRIME, would lead to a greater likelihood of publishing research from residency and accessing adequate career mentorship and would be influential on subsequent alumni careers. We performed a cross-sectional survey of internal medicine residency alumni from UCSF who graduated in 2001 through 2010. We compared responses of PRIME and non-PRIME categorical alumni. We used Pearson's chi-square and Student's t test to compare PRIME and non-PRIME alumni on categorical and continuous variables. Sixty-six percent (211/319) of alumni responded to the survey. A higher percentage of PRIME alumni published residency research projects compared to non-PRIME alumni (64% vs. 40%; p = .002). The number of PRIME alumni identifying research as their primary career role was not significantly different from non-PRIME internal medicine residency graduates (35% of PRIME vs. 29% non-PRIME). Process measures that could explain these findings include adequate access to mentors (M 4.4 for PRIME vs. 3.6 for non-PRIME alumni, p medicine residency programs.

  19. Performance during internal medicine residency training and subsequent disciplinary action by state licensing boards.

    Science.gov (United States)

    Papadakis, Maxine A; Arnold, Gerald K; Blank, Linda L; Holmboe, Eric S; Lipner, Rebecca S

    2008-06-03

    Physicians who are disciplined by state licensing boards are more likely to have demonstrated unprofessional behavior in medical school. Information is limited on whether similar performance measures taken during residency can predict performance as practicing physicians. To determine whether performance measures during residency predict the likelihood of future disciplinary actions against practicing internists. Retrospective cohort study. State licensing board disciplinary actions against physicians from 1990 to 2006. 66,171 physicians who entered internal medicine residency training in the United States from 1990 to 2000 and became diplomates. Predictor variables included components of the Residents' Annual Evaluation Summary ratings and American Board of Internal Medicine (ABIM) certification examination scores. 2 performance measures independently predicted disciplinary action. A low professionalism rating on the Residents' Annual Evaluation Summary predicted increased risk for disciplinary action (hazard ratio, 1.7 [95% CI, 1.3 to 2.2]), and high performance on the ABIM certification examination predicted decreased risk for disciplinary action (hazard ratio, 0.7 [CI, 0.60 to 0.70] for American or Canadian medical school graduates and 0.9 [CI, 0.80 to 1.0] for international medical school graduates). Progressively better professionalism ratings and ABIM certification examination scores were associated with less risk for subsequent disciplinary actions; the risk ranged from 4.0% for the lowest professionalism rating to 0.5% for the highest and from 2.5% for the lowest examination scores to 0.0% for the highest. The study was retrospective. Some diplomates may have practiced outside of the United States. Nondiplomates were excluded. Poor performance on behavioral and cognitive measures during residency are associated with greater risk for state licensing board actions against practicing physicians at every point on a performance continuum. These findings support

  20. Problem-based learning in laboratory medicine resident education: a satisfaction survey.

    Science.gov (United States)

    Lepiller, Quentin; Solis, Morgane; Velay, Aurélie; Gantner, Pierre; Sueur, Charlotte; Stoll-Keller, Françoise; Barth, Heidi; Fafi-Kremer, Samira

    2017-04-01

    Theoretical knowledge in biology and medicine plays a substantial role in laboratory medicine resident education. In this study, we assessed the contribution of problem-based learning (PBL) to improve the training of laboratory medicine residents during their internship in the department of virology, Strasbourg University Hospital, France. We compared the residents' satisfaction regarding an educational program based on PBL and a program based on lectures and presentations. PBL induced a high level of satisfaction (100%) among residents compared to lectures and presentations (53%). The main advantages of this technique were to create a situational interest regarding virological problems, to boost the residents' motivation and to help them identify the most relevant learning objectives in virology. However, it appears pertinent to educate the residents in appropriate bibliographic research techniques prior to PBL use and to monitor their learning by regular formative assessment sessions.

  1. THE EFFECT OF COMMUNICATION SKILLS TRAINING PROGRAMME ON THE ATTITUDE AND PERCEPTIONS OF THE RESIDENTS OF PHYSICAL MEDICINE AND REHABILITATION

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    Reeba Mary Mani

    2016-12-01

    Full Text Available BACKGROUND Communication skills are essential for all practicing doctors, which can be taught and assessed by a structured programme. Hence, a specialty-based communication skills training programme was conducted among the residents of the Physical Medicine and Rehabilitation (PMR Department. The aim of the study is to assess the change in attitude and perception among the residents of PMR by a communication skills training programme. MATERIALS AND METHODS It comprised of a data collection procedure. Here, a semi-structured questionnaire was administered to the subjects. It was given as a pre-intervention, post-intervention and as a second phase post-intervention questionnaire. The communication skills training programme (n=16 was conducted after a pre-test evaluation using the validated questionnaire tool. A half-day training programme using composite Teaching-Learning methods (lectures/role play/videos/check list were included. The post-test-1 (n=16 was conducted after the training programme and the post-test-2 (n=16 was conducted after 6 weeks. All the tests used the same validated questionnaire tool with scores allocated to each item. Settings- Physical Medicine and Rehabilitation (PMR Department among the residents. Study Design- Educational Intervention- A communication skills training programme using composite teaching learning methods. Statistical Analysis- Analysed using SPSS-16 package software. RESULTS The median pre-test score of the sixteen PMR residents was noted to be 33. The median post-test-1 score of the group was noted to be 37. A significant difference was noted between the pre- and post-test-1 score, which was statistically significant Wilcoxon Signed Rank Test z=-3.249 and p value <0.0001. The post-test-2, which was done after 6 weeks of the programme yielded a score of 36, a similar value of post-test-1. The comparison of pre-test score with post-test-1 and post-test-2 scores showed a highly significant improvement in the

  2. Resident cross-cultural training, satisfaction, and preparedness.

    Science.gov (United States)

    Frintner, Mary Pat; Mendoza, Fernando S; Dreyer, Benard P; Cull, William L; Laraque, Danielle

    2013-01-01

    To describe the diversity of pediatric residents and examine relationships of cross-cultural training experiences with training satisfaction, perceived preparedness for providing culturally effective care, and attitudes surrounding care for underserved populations. A cross-sectional survey was conducted of a national random sample of graduating pediatric residents and an additional sample of minority residents. Using weighted analysis, we used multivariate regression to test for differences in satisfaction, preparedness, and attitudes between residents with more and less cross-cultural experiences during residency, controlling for residents' characteristics and experiences before training. The survey response rate was 57%. Eleven percent were Hispanic, 61% white, 21% Asian, 9% African American, 9% other racial/ethnic groups; 34% grew up in a bi- or multilingual family. Ninety-three percent of residents were satisfied with their residency training, 81% with the instruction they received on health and health care disparities, and 54% on global health issues. Ninety-six percent of residents felt they were prepared to care for patients from diverse backgrounds, but fewer felt prepared to care for families with beliefs at odds with Western medicine (49%) and families who receive alternative or complementary care (37%). Residents with more cross-cultural experiences during residency reported being better prepared than those with less experience to care for families with limited English proficiency (adjusted odds ratio [aOR] 2.11; 95% confidence interval [CI] 1.40-3.17), new immigrants (aOR 1.91; 95% CI 1.32-2.75), and with religious beliefs that might affect clinical care (aOR 1.62; 95% CI 1.13-2.32). Pediatric residents begin their training with diverse cross-cultural backgrounds and experiences. Residency experiences in cross-cultural care contribute to feelings of preparedness to care for diverse US children. Copyright © 2013 Academic Pediatric Association. Published

  3. Training Pathology Residents to Practice 21st Century Medicine

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    W. Stephen Black-Schaffer MA, MD

    2016-09-01

    Full Text Available Scientific advances, open information access, and evolving health-care economics are disrupting extant models of health-care delivery. Physicians increasingly practice as team members, accountable to payers and patients, with improved efficiency, value, and quality. This change along with a greater focus on population health affects how systems of care are structured and delivered. Pathologists are not immune to these disruptors and, in fact, may be one of the most affected medical specialties. In the coming decades, it is likely that the number of practicing pathologists will decline, requiring each pathologist to serve more and often sicker patients. The demand for increasingly sophisticated yet broader diagnostic skills will continue to grow. This will require pathologists to acquire appropriate professional training and interpersonal skills. Today’s pathology training programs are ill designed to prepare such practitioners. The time to practice for most pathology trainees is typically 5 to 6 years. Yet, trainees often lack sufficient experience to practice independently and effectively. Many studies have recognized these challenges suggesting that more effective training for this new century can be implemented. Building on the strengths of existing programs, we propose a redesign of pathology residency training that will meet (and encourage a continuing evolution of American Board of Pathology and Accreditation Council for Graduate Medical Education requirements, reduce the time to readiness for practice, and produce more effective, interactive, and adaptable pathologists. The essence of this new model is clear definition and acquisition of core knowledge and practice skills that span the anatomic and clinical pathology continuum during the first 2 years, assessed by competency-based metrics with emphasis on critical thinking and skill acquisition, followed by individualized modular training with intensively progressive responsibility

  4. Internal Medicine Residents Do Not Accurately Assess Their Medical Knowledge

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    Jones, Roger; Panda, Mukta; Desbiens, Norman

    2008-01-01

    Background: Medical knowledge is essential for appropriate patient care; however, the accuracy of internal medicine (IM) residents' assessment of their medical knowledge is unknown. Methods: IM residents predicted their overall percentile performance 1 week (on average) before and after taking the in-training exam (ITE), an objective and well…

  5. A survey of resident physicians′ knowledge concerning transfusion medicine in Shiraz, Iran

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    Leila Kasraian

    2014-01-01

    Full Text Available Objective: The knowledge of physicians concerning blood transfusion has a significant impact on the optimal use of blood and blood products. The aim was to survey their knowledge regarding this area and identify whether additional training is required. Material and Methods: This cross-sectional study was conducted on all 1 st year resident physicians at Shiraz University of Medical Sciences, Iran in 2011. The questionnaire solicited information on demographic variables, knowledge regarding transfusion medicine, education and experience regarding blood transfusion. Results: The mean total knowledge score regarding transfusion medicine was 15.44 ± 3.3 (7-25 out of 29. Only about one-fourth (27.4% replied correctly to over 60% of questions. The mean score of knowledge was higher among residents who stated that they received special training regarding blood transfusion in their medical courses (P < 0.01. Seventy-five percent of residents believed that they had received insufficient education and 97.8% believed that they need additional training. Conclusion: The results reflect the uncertainties among resident physicians regarding blood transfusion. It has been suggested that a special transfusion medicine educational program should be added to the medical education curriculum.

  6. A Formalized Three-Year Emergency Medicine Residency Ultrasound Education Curriculum

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    Andrew King

    2016-09-01

    Full Text Available Audience and type of curriculum: The Ohio State University Wexner Medical Center Emergency Medicine Residency Program Ultrasound Education Curriculum is a three-year curriculum for PGY-1 to PGY-3 learners. Introduction/Background: Each year of the three-year The Ohio State University Wexner Medical Center Emergency Medicine Ultrasound Curriculum focuses on different aspects of emergency ultrasonography, thereby promoting progressive understanding and utilization of point-of-care ultrasound in medical decision-making during residency training. Ultrasound is an invaluable bedside tool for emergency physicians; this skill must be mastered by resident learners during residency training, and ultrasound competency is a required ACGME milestone.1 The American College of Emergency Physicians (ACEP currently recommends that 11 applications of emergency ultrasound be part of the core skills of an emergency physician.2 This curriculum acknowledges the standards developed by ACEP and the ACGME. Objectives: Learners will 1 know the indications for each the 11 ACEP point-of-care ultrasound (POCUS applications; 2 perform each of the 11 ACEP POCUS applications; 3 integrate POCUS into medical decision-making. Methods: The educational strategies used in this curriculum include: independent, self-directed learning (textbook and literature reading, brief didactic sessions describing indications and technique for each examination, hands-on ultrasound scanning under the direct supervision of ultrasound faculty with real-time feedback, and quality assurance review of ultrasound images. Residents are expected to perform a minimum of 150 ultrasound examinations with associated quality assurance during the course of their residency training. The time requirements, reading material, and ultrasound techniques taught vary depending on the year of training. Length of curriculum: The entirety of the curriculum is three years; however, each year of residency training has

  7. Filling the Gap: Simulation-based Crisis Resource Management Training for Emergency Medicine Residents

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    Jessica R. Parsons

    2017-12-01

    Full Text Available Introduction In today’s team-oriented healthcare environment, high-quality patient care requires physicians to possess not only medical knowledge and technical skills but also crisis resource management (CRM skills. In emergency medicine (EM, the high acuity and dynamic environment makes CRM skills of physicians particularly critical to healthcare team success. The Accreditation Council of Graduate Medicine Education Core Competencies that guide residency program curriculums include CRM skills; however, EM residency programs are not given specific instructions as to how to teach these skills to their trainees. This article describes a simulation-based CRM course designed specifically for novice EM residents. Methods The CRM course includes an introductory didactic presentation followed by a series of simulation scenarios and structured debriefs. The course is designed to use observational learning within simulation education to decrease the time and resources required for implementation. To assess the effectiveness in improving team CRM skills, two independent raters use a validated CRM global rating scale to measure the CRM skills displayed by teams of EM interns in a pretest and posttest during the course. Results The CRM course improved leadership, problem solving, communication, situational awareness, teamwork, resource utilization and overall CRM skills displayed by teams of EM interns. While the improvement from pretest to posttest did not reach statistical significance for this pilot study, the large effect sizes suggest that statistical significance may be achieved with a larger sample size. Conclusion This course can feasibly be incorporated into existing EM residency curriculums to provide EM trainees with basic CRM skills required of successful emergency physicians. We believe integrating CRM training early into existing EM education encourages continued deliberate practice, discussion, and improvement of essential CRM skills.

  8. Predicting performance using background characteristics of international medical graduates in an inner-city university-affiliated Internal Medicine residency training program

    Science.gov (United States)

    Kanna, Balavenkatesh; Gu, Ying; Akhuetie, Jane; Dimitrov, Vihren

    2009-01-01

    Background IMGs constitute about a third of the United States (US) internal medicine graduates. US residency training programs face challenges in selection of IMGs with varied background features. However data on this topic is limited. We analyzed whether any pre-selection characteristics of IMG residents in our internal medicine program are associated with selected outcomes, namely competency based evaluation, examination performance and success in acquiring fellowship positions after graduation. Methods We conducted a retrospective study of 51 IMGs at our ACGME accredited teaching institution between 2004 and 2007. Background resident features namely age, gender, self-reported ethnicity, time between medical school graduation to residency (pre-hire time), USMLE step I & II clinical skills scores, pre-GME clinical experience, US externship and interest in pursuing fellowship after graduation expressed in their personal statements were noted. Data on competency-based evaluations, in-service exam scores, research presentation and publications, fellowship pursuance were collected. There were no fellowships offered in our hospital in this study period. Background features were compared between resident groups according to following outcomes: (a) annual aggregate graduate PGY-level specific competency-based evaluation (CBE) score above versus below the median score within our program (scoring scale of 1 – 10), (b) US graduate PGY-level specific resident in-training exam (ITE) score higher versus lower than the median score, and (c) those who succeeded to secure a fellowship within the study period. Using appropriate statistical tests & adjusted regression analysis, odds ratio with 95% confidence intervals were calculated. Results 94% of the study sample were IMGs; median age was 35 years (Inter-Quartile range 25th – 75th percentile (IQR): 33–37 years); 43% women and 59% were Asian physicians. The median pre-hire time was 5 years (IQR: 4–7 years) and USMLE step

  9. Quality assessment and improvement of post graduate family medicine training in the USA.

    Science.gov (United States)

    Hoekzema, Grant S; Maxwell, Lisa; Gravel, Joseph W; Mills, Walter W; Geiger, William; Honeycutt, J David

    2016-09-01

    In 2013, the World Organisation of Family Doctors published training standards for post-graduate medical education (GME) in Family Medicine/General Practice (FP/GP). GME quality has not been well-defined, other than meeting accreditation standards. In 2009, the Association of Family Medicine Residency Directors (AFMRD) developed a tool that would aid in raising the quality of family medicine residency training in the USA. We describe the development of this quality improvement tool, which we called the residency performance index (RPI), and its first three years of use by US family medicine residency (FMR) programmes. The RPI uses metrics specific to family medicine training in the USA to help programmes identify strengths and areas for improvement in their educational activities. Our review of three years of experience with the RPI revealed difficulties with collecting data, and lack of information on graduates' scope of practice. It also showed the potential usefulness of the tool as a programme improvement mechanism. The RPI is a nationwide, standardised, programme quality improvement tool for family medicine residency programmes in the USA, which was successfully launched as part of AFMRD's strategic plan. Although some initial challenges need to be addressed, it has the promise to aid family medicine residencies in their internal improvement efforts. This model could be adapted in other post-graduate training settings in FM/GP around the world.

  10. Remediation plans in family medicine residency

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    Audétat, Marie-Claude; Voirol, Christian; Béland, Normand; Fernandez, Nicolas; Sanche, Gilbert

    2015-01-01

    Abstract Objective To assess use of the remediation instrument that has been implemented in training sites at the University of Montreal in Quebec to support faculty in diagnosing and remediating resident academic difficulties, to examine whether and how this particular remediation instrument improves the remediation process, and to determine its effects on the residents’ subsequent rotation assessments. Design A multimethods approach in which data were collected from different sources: remediation plans developed by faculty, program statistics for the corresponding academic years, and students’ academic records and rotation assessment results. Setting Family medicine residency program at the University of Montreal. Participants Family medicine residents in academic difficulty. Main outcome measures Assessment of the content, process, and quality of remediation plans, and students’ academic and rotation assessment results (successful, below expectations, or failure) both before and after the remediation period. Results The framework that was developed for assessing remediation plans was used to analyze 23 plans produced by 10 teaching sites for 21 residents. All plans documented cognitive problems and implemented numerous remediation measures. Although only 48% of the plans were of good quality, implementation of a remediation plan was positively associated with the resident’s success in rotations following the remediation period. Conclusion The use of remediation plans is well embedded in training sites at the University of Montreal. The residents’ difficulties were mainly cognitive in nature, but this generally related to deficits in clinical reasoning rather than knowledge gaps. The reflection and analysis required to produce a remediation plan helps to correct many academic difficulties and normalize the academic career of most residents in difficulty. Further effort is still needed to improve the quality of plans and to support teachers.

  11. An assessment of emergency medicine residents' ability to perform in a multitasking environment.

    Science.gov (United States)

    Ledrick, David; Fisher, Susan; Thompson, Justin; Sniadanko, Mark

    2009-09-01

    Multitasking (MT) is a term often applied to emergency medicine (EM), but it is still poorly understood. In an effort to facilitate MT research in EM, the authors conducted this pilot study to describe EM residents' scores on a Multi-Tasking Assessment Tool (MTAT) and compare these scores with the residents' work efficiency in the emergency department. The authors administered a previously developed test of MT ability to EM residents. They performed a multiple regression analysis to determine the effect of MT ability on resident work efficiency, defining efficiency as the number of relative value units billed per hour. They controlled the analysis for year of training and medical knowledge using as a standard the in-service exam administered by the American Board of Emergency Medicine. Complete data for 35 residents were available for analysis. Work efficiency was multivariately correlated with MTAT scores and year of training (P training explained the majority of the variance, a resident's MT ability accounted for a smaller but still significant portion. This pilot study further validates the MTAT and lays the groundwork for further research in MT in EM. Resident year of training and MTAT scores explain the variability in resident work efficiency significantly more than medical knowledge. Understanding MT ability may ultimately help in resident selection, education, and remediation as well as career counseling and improvement of practice systems in EM.

  12. Self vs. Other Focus: Predicting Professionalism Remediation of Emergency Medicine Residents

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    Robert E. Thaxton

    2017-12-01

    Full Text Available Introduction Unprofessionalism is a major reason for resident dismissal from training. Because of the high stakes involved, residents and educators alike would benefit from information predicting whether they might experience challenges related to this competency. Our objective was to correlate the outcome of professionalism-related remedial actions during residency with the predictor variable of resident response to a standardized interview question: “Why is Medicine important to you?” Methods We conducted a professional development quality improvement (QI initiative to improve resident education and mentorship by achieving a better understanding of each resident’s reasons for valuing a career in medicine. This initiative entailed an interview administered to each resident beginning emergency medicine training at San Antonio Military Medical Center during 2006–2013. The interviews uniformly began with the standardized question “Why is Medicine important to you?” The residency program director documented a free-text summary of each response to this question, the accuracy of which was confirmed by the resident. We analyzed the text of each resident’s response after a review of the QI data suggested an association between responses and professionalism actions (retrospective cohort design. Two associate investigators blinded to all interview data, remedial actions, and resident identities categorized each text response as either self-focused (e.g., “I enjoy the challenge” or other-focused (e.g., “I enjoy helping patients”. Additional de-identified data collected included demographics, and expressed personal importance of politics and religion. The primary outcome was a Clinical Competency Committee professionalism remedial action. Results Of 114 physicians starting residency during 2006–2013, 106 (93.0% completed the interview. There was good inter-rater reliability in associate investigator categorization of resident

  13. Validity and reliability of an in-training evaluation report to measure the CanMEDS roles in emergency medicine residents.

    Science.gov (United States)

    Kassam, Aliya; Donnon, Tyrone; Rigby, Ian

    2014-03-01

    There is a question of whether a single assessment tool can assess the key competencies of residents as mandated by the Royal College of Physicians and Surgeons of Canada CanMEDS roles framework. The objective of the present study was to investigate the reliability and validity of an emergency medicine (EM) in-training evaluation report (ITER). ITER data from 2009 to 2011 were combined for residents across the 5 years of the EM residency training program. An exploratory factor analysis with varimax rotation was used to explore the construct validity of the ITER. A total of 172 ITERs were completed on residents across their first to fifth year of training. A combined, 24-item ITER yielded a five-factor solution measuring the CanMEDs role Medical Expert/Scholar, Communicator/Collaborator, Professional, Health Advocate and Manager subscales. The factor solution accounted for 79% of the variance, and reliability coefficients (Cronbach alpha) ranged from α  =  0.90 to 0.95 for each subscale and α  =  0.97 overall. The combined, 24-item ITER used to assess residents' competencies in the EM residency program showed strong reliability and evidence of construct validity for assessment of the CanMEDS roles. Further research is needed to develop and test ITER items that will differentiate each CanMEDS role exclusively.

  14. Principles to Consider in Defining New Directions in Internal Medicine Training and Certification

    Science.gov (United States)

    Turner, Barbara J; Centor, Robert M; Rosenthal, Gary E

    2006-01-01

    SGIM endoreses seven principles related to current thinking about internal medicine training: 1) internal medicine requires a full three years of residency training before subspecialization; 2) internal medicine residency programs must dramatically increase support for training in the ambulatory setting and offer equivalent opportunities for training in both inpatient and outpatient medicine; 3) in settings where adequate support and time are devoted to ambulatory training, the third year of residency could offer an opportunity to develop further expertise or mastery in a specific type or setting of care; 4) further certification in specific specialties within internal medicine requires the completion of an approved fellowship program; 5) areas of mastery in internal medicine can be demonstrated through modified board certification and recertification examinations; 6) certification processes throughout internal medicine should focus increasingly on demonstration of clinical competence through adherence to validated standards of care within and across practice settings; and 7) regardless of the setting in which General Internists practice, we should unite to promote the critical role that this specialty serves in patient care. PMID:16637826

  15. ACR-SNM Task Force on Nuclear Medicine Training: report of the task force.

    Science.gov (United States)

    Guiberteau, Milton J; Graham, Michael M

    2011-06-01

    The expansion of knowledge and technological advances in nuclear medicine and radiology require physicians to have more expertise in functional and anatomic imaging. The convergence of these two specialties into the new discipline of molecular imaging has also begun to place demands on residency training programs for additional instruction in physiology and molecular biology. These changes have unmasked weaknesses in current nuclear medicine and radiology training programs. Adding to the impetus for change are the attendant realities of the job market and uncertain employment prospects for physicians trained in nuclear medicine but not also trained in diagnostic radiology. With this background, the ACR and the Society of Nuclear Medicine convened the Task Force on Nuclear Medicine Training to define the issues and develop recommendations for resident training.

  16. A comparison of simulation-based education versus lecture-based instruction for toxicology training in emergency medicine residents.

    Science.gov (United States)

    Maddry, Joseph K; Varney, Shawn M; Sessions, Daniel; Heard, Kennon; Thaxton, Robert E; Ganem, Victoria J; Zarzabal, Lee A; Bebarta, Vikhyat S

    2014-12-01

    Simulation-based teaching (SIM) is a common method for medical education. SIM exposes residents to uncommon scenarios that require critical, timely actions. SIM may be a valuable training method for critically ill poisoned patients whose diagnosis and treatment depend on key clinical findings. Our objective was to compare medical simulation (SIM) to traditional lecture-based instruction (LEC) for training emergency medicine (EM) residents in the acute management of critically ill poisoned patients. EM residents completed two pre-intervention questionnaires: (1) a 24-item multiple-choice test of four toxicological emergencies and (2) a questionnaire using a five-point Likert scale to rate the residents' comfort level in diagnosing and treating patients with specific toxicological emergencies. After completing the pre-intervention questionnaires, residents were randomized to SIM or LEC instruction. Two toxicologists and three EM physicians presented four toxicology topics to both groups in four 20-min sessions. One group was in the simulation center, and the other in a lecture hall. Each group then repeated the multiple-choice test and questionnaire immediately after instruction and again at 3 months after training. Answers were not discussed. The primary outcome was comparison of immediate mean post-intervention test scores and final scores 3 months later between SIM and LEC groups. Test score outcomes between groups were compared at each time point (pre-test, post-instruction, 3-month follow-up) using Wilcoxon rank sum test. Data were summarized by descriptive statistics. Continuous variables were characterized by means (SD) and tested using t tests or Wilcoxon rank sum. Categorical variables were summarized by frequencies (%) and compared between training groups with chi-square or Fisher's exact test. Thirty-two EM residents completed pre- and post-intervention tests and comfort questionnaires on the study day. Both groups had higher post-intervention mean test

  17. Home Care Services as Teaching Sites for Geriatrics in Family Medicine Residencies.

    Science.gov (United States)

    Laguillo, Edgardo

    1988-01-01

    A national survey of family medicine programs and residency training in geriatrics found almost half using home care services as teaching sites. In the program design preferred by residents, the resident followed the patient long-term and discussed management with a multidisciplinary team. An alternative combined rotation is discussed. (Author/MSE)

  18. Pediatric Integrative Medicine in Residency Program: Relationship between Lifestyle Behaviors and Burnout and Wellbeing Measures in First-Year Residents.

    Science.gov (United States)

    McClafferty, Hilary; Brooks, Audrey J; Chen, Mei-Kuang; Brenner, Michelle; Brown, Melanie; Esparham, Anna; Gerstbacher, Dana; Golianu, Brenda; Mark, John; Weydert, Joy; Yeh, Ann Ming; Maizes, Victoria

    2018-04-23

    It is widely recognized that burnout is prevalent in medical culture and begins early in training. Studies show pediatricians and pediatric trainees experience burnout rates comparable to other specialties. Newly developed Accreditation Council for Graduate Medical Education (ACGME) core competencies in professionalism and personal development recognize the unacceptably high resident burnout rates and present an important opportunity for programs to improve residents experience throughout training. These competencies encourage healthy lifestyle practices and cultivation of self-awareness, self-regulation, empathy, mindfulness, and compassion—a paradigm shift from traditional medical training underpinned by a culture of unrealistic endurance and self-sacrifice. To date, few successful and sustainable programs in resident burnout prevention and wellness promotion have been described. The University of Arizona Center for Integrative Medicine Pediatric Integrative Medicine in Residency (PIMR) curriculum, developed in 2011, was designed in part to help pediatric programs meet new resident wellbeing requirements. The purpose of this paper is to detail levels of lifestyle behaviors, burnout, and wellbeing for the PIMR program’s first-year residents ( N = 203), and to examine the impact of lifestyle behaviors on burnout and wellbeing. The potential of the PIMR to provide interventions addressing gaps in lifestyle behaviors with recognized association to burnout is discussed.

  19. Pediatric Integrative Medicine in Residency Program: Relationship between Lifestyle Behaviors and Burnout and Wellbeing Measures in First-Year Residents

    Directory of Open Access Journals (Sweden)

    Hilary McClafferty

    2018-04-01

    Full Text Available It is widely recognized that burnout is prevalent in medical culture and begins early in training. Studies show pediatricians and pediatric trainees experience burnout rates comparable to other specialties. Newly developed Accreditation Council for Graduate Medical Education (ACGME core competencies in professionalism and personal development recognize the unacceptably high resident burnout rates and present an important opportunity for programs to improve residents experience throughout training. These competencies encourage healthy lifestyle practices and cultivation of self-awareness, self-regulation, empathy, mindfulness, and compassion—a paradigm shift from traditional medical training underpinned by a culture of unrealistic endurance and self-sacrifice. To date, few successful and sustainable programs in resident burnout prevention and wellness promotion have been described. The University of Arizona Center for Integrative Medicine Pediatric Integrative Medicine in Residency (PIMR curriculum, developed in 2011, was designed in part to help pediatric programs meet new resident wellbeing requirements. The purpose of this paper is to detail levels of lifestyle behaviors, burnout, and wellbeing for the PIMR program’s first-year residents (N = 203, and to examine the impact of lifestyle behaviors on burnout and wellbeing. The potential of the PIMR to provide interventions addressing gaps in lifestyle behaviors with recognized association to burnout is discussed.

  20. Benchmarks for Support and Outcomes for Internal Medicine-Pediatrics Residency Programs: A 5-Year Review.

    Science.gov (United States)

    Aronica, Michael; Williams, Ronald; Dennar, Princess E; Hopkins, Robert H

    2015-12-01

    Combined internal medicine and pediatrics (medicine-pediatrics) residencies were Accreditation Council for Graduate Medical Education (ACGME) accredited separately from their corresponding categorical residencies in June 2006. We investigated how ACGME accreditation of medicine-pediatrics programs has affected the levels of support (both financial and personnel), the National Resident Matching Program (NRMP) match rate, performance on the board examination, and other graduate outcomes. From 2009 through 2013 we sent an annual SurveyMonkey online survey to members of the Medicine-Pediatrics Program Directors Association. Questions pertained to program characteristics, program director support, recruitment, ambulatory training, and graduate data. More than 79% of responders completed the entire survey for each year (sample size was 60 program directors). Compared to the time prior to accreditation of the specialty, there was an increase in program directors who are dually trained (89% versus 93%), an increase in program director salary ($134,000 before accreditation versus $185,000 in 2013, P Pediatrics examination was comparable to that for pediatrics residents. Since accreditation, a larger number of residents are choosing careers in hospital medicine. Our data show widespread improved support for medicine-pediatrics programs since the 2006 start of ACGME accreditation.

  1. Designing and implementing a resiliency program for family medicine residents.

    Science.gov (United States)

    Brennan, Julie; McGrady, Angele

    2015-01-01

    Family medicine residents are at risk for burnout due to extended work hours, lack of control over their work schedule, and challenging work situations and environments. Building resiliency can prevent burnout and may improve a resident's quality of life and health behavior. This report describes a program designed to build resiliency, the ability to bounce back from stress, in family medicine residents in a medium sized U.S. residency training program. Interactive sessions emphasized building self-awareness, coping skills, strengths and meaning in work, time management, self-care, and connections in and outside of medicine to support resident well-being. System changes which fostered wellness were also implemented. These changes included increasing the availability of fresh fruits in the conference and call room, purchasing an elliptical exercise machine for the on call room, and offering a few minutes of mindfulness meditation daily to the inpatient residents. Results to date show excellent acceptance of the program by trainees, increased consumption of nutritious foods, more personal exercise, and self-reported decreased overreactions to stress. Resiliency programs can effectively serve to meet accreditation requirements while fostering residents' abilities to balance personal and professional demands. © The Author(s) 2015.

  2. The Impact of the Hospital Volume on the Performance of Residents on the General Medicine In-Training Examination: A Multicenter Study in Japan.

    Science.gov (United States)

    Mizuno, Atsushi; Tsugawa, Yusuke; Shimizu, Taro; Nishizaki, Yuji; Okubo, Tomoya; Tanoue, Yusuke; Konishi, Ryota; Shiojiri, Toshiaki; Tokuda, Yasuharu

    2016-01-01

    Objective Although several studies have been conducted worldwide on factors that might improve residents' knowledge, the relationship between the hospital volume and the internal medicine residents' knowledge has not been fully understood. We conducted a cross-sectional study to compare the relationships of the hospital volume and hospital resources with the residents' knowledge assessed by the In-training Examination. Methods We conducted a retrospective survey and a clinical knowledge evaluation of postgraduate year 1 and 2 (PGY-1 and -2) resident physicians in Japan by using the General Medicine In-training Examination (GM-ITE) in 2014. We compared the ITE score and the hospital volume. Results A total of 2,015 participants (70.6% men; age, 27.3±2.9 years old) from 208 hospitals were retrospectively analyzed. Generalized estimating equations were used, and the results revealed that an increasing number of hospitalizations, decreasing staff number, decreasing age and PGY-2 were significantly associated with higher GM-ITE scores. Conclusion The hospital volume, such as the number of hospitalizations, is thus considered to have a positive impact on the GM-ITE scores.

  3. Innovative partnerships to advance public health training in community-based academic residency programs

    Directory of Open Access Journals (Sweden)

    Lo JC

    2017-10-01

    Full Text Available Joan C Lo,1–3 Thomas E Baudendistel,2,3 Abhay Dandekar,3,4 Phuoc V Le,5 Stanton Siu,2,3 Bruce Blumberg6 1Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; 2Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA; 3Graduate Medical Education, Kaiser Permanente East Bay, Oakland, CA, USA; 4Department of Pediatrics, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA; 5School of Public Health, University of California Berkeley, Berkeley, CA, USA; 6Graduate Medical Education, Kaiser Permanente Northern California, Oakland, CA, USA Abstract: Collaborative partnerships between community-based academic residency ­training programs and schools of public health, represent an innovative approach to training future physician leaders in population management and public health. In Kaiser Permanente Northern California, development of residency-Masters in Public Health (MPH tracks in the Internal Medicine Residency and the Pediatrics Residency programs, with MPH graduate studies completed at the University of California Berkeley School of Public Health, enables physicians to integrate clinical training with formal education in epidemiology, biostatistics, health policy, and disease prevention. These residency-MPH programs draw on more than 50 years of clinical education, public health training, and health services research – creating an environment that sparks inquiry and added value by developing skills in patient-centered care through the lens of population-based outcomes. Keywords: graduate medical education, public health, master’s degree, internal medicine, pediatrics, residency training

  4. Family medicine training in Saudi Arabia: Are there any variations among different regions?

    Directory of Open Access Journals (Sweden)

    Ammar R Abu Zuhairah

    2015-01-01

    Full Text Available Aims: The aim was to compare Eastern, Makkah, and Asir regions in term of residents′ perception of the achievement of training objectives, and to assess various rotations based on residents′ perception. Settings and Design: This cross-sectional study was done among family medicine residents in the Eastern, Makkah, and Asir regions. Methodology: A questionnaire was developed by the investigator and validated by two experts. All residents, except R1 residents, were included. All data were collected by the investigator by direct contact with the residents. Statistical Analysis Used: Cronbach′s alpha, analysis of variance, t-test, and univariate regression model as appropriate, were used. Results: Reliability of the questionnaire was found to be 75.4%. One hundred and seven (response rate: 83.6% residents completed the questionnaire. There were 51 (47.7%, 27 (25.2%, and 29 (27.1% residents in the program in the Eastern region, Makkah, and Asir, respectively. The mean age was 29.1 ± 2.5 years; half of the residents were male, most of (83.2% were married, and more than half (54.2% of had worked in primary health care before joining the program. Overall, 45% of the residents perceived that they had achieved the training objectives. The highest rotations as perceived by the residents were psychiatry and otolaryngology while the lowest were orthopedics and ophthalmology. There were significant differences among the study regions with regard to the rotations in family medicine, internal medicine, orthopedics, general surgery, and emergency medicine. Conclusions: Overall, a good percentage of the residents perceived that they had achieved the training objectives. The rotations differed in the studied regions. Psychiatry and otolaryngology had the highest percentage of family medicine residents who perceived that they had achieved the training objectives while lowest was in internal medicine and obstetrics and gynecology. The highest rotations as

  5. Development of a novel sports medicine rotation for emergency medicine residents.

    Science.gov (United States)

    Waterbrook, Anna L; Pritchard, T Gail; Lane, Allison D; Stoneking, Lisa R; Koch, Bryna; McAtee, Robert; Grall, Kristi H; Min, Alice A; Prior, Jessica; Farrell, Isaac; McNulty, Holly G; Stolz, Uwe

    2016-01-01

    Musculoskeletal complaints are the most common reason for patients to visit a physician, yet competency in musculoskeletal medicine is invariably reported as a deficiency in medical education in the USA. Sports medicine clinical rotations improve both medical students' and residents' musculoskeletal knowledge. Despite the importance of this knowledge, a standardized sports medicine curriculum in emergency medicine (EM) does not exist. Hence, we developed a novel sports medicine rotation for EM residents to improve their musculoskeletal educational experience and to improve their knowledge in musculoskeletal medicine by teaching the evaluation and management of many common musculoskeletal disorders and injuries that are encountered in the emergency department. The University of Arizona has two distinct EM residency programs, South Campus (SC) and University Campus (UC). The UC curriculum includes a traditional 4-week orthopedic rotation, which consistently rated poorly on evaluations by residents. Therefore, with the initiation of a new EM residency at SC, we replaced the standard orthopedic rotation with a novel sports medicine rotation for EM interns. This rotation includes attendance at sports medicine clinics with primary care and orthopedic sports medicine physicians, involvement in sport event coverage, assigned reading materials, didactic experiences, and an on-call schedule to assist with reductions in the emergency department. We analyzed postrotation surveys completed by residents, postrotation evaluations of the residents completed by primary care sports medicine faculty and orthopedic chief residents, as well as the total number of dislocation reductions performed by each graduating resident at both programs over the last 5 years. While all residents in both programs exceeded the ten dislocation reductions required for graduation, residents on the sports medicine rotation had a statistically significant higher rate of satisfaction of their educational

  6. Trends in violence education in family medicine residency curricula.

    Science.gov (United States)

    Cronholm, Peter F; Singh, Vijay; Fogarty, Colleen T; Ambuel, Bruce

    2014-09-01

    Violence is a significant public health issue with far-reaching implications for the health of individuals and their communities. Our objective was to describe trends in violence-related training in family medicine residency programs since the last national survey was conducted in 1997. Surveys were sent to 337 US family medicine residency programs with the program director having active Society of Teachers of Family Medicine (STFM) membership. Measures included residency setting and characteristics, violence-related curricular content, teaching techniques and personnel, timing of content, and impact of changes in Residency Review Committee (RRC) and Accreditation Council for Graduate Medical Education (ACGME) requirements. Descriptive statistics and bivariate analyses comparing measures across time were used. A total of 201 (60%) surveys were completed. The most common violence curricula was child (83%) and elder abuse (76%), and the most common teachers of violence-related content were family physicians, psychologists, and social workers. The most common teaching methods were clinical precepting (94%), lectures (90%), case vignettes (71%), and intimate partner violence (IPV) shelter experiences (67%). ACGME and RRC changes were not reflected in self-reported measures of curricular emphasis or time. Violence curricular content and number of hours has been constant in family medicine residencies over time. An increase in the reported use of active learning strategies was identified as a trend across surveys. Next steps for violence curricula involve assessment of residents' competency to identify and intervene in violence.

  7. A Learning-Curve Approach to the Self-Assessment of Internal Medicine Training.

    Science.gov (United States)

    Day, Susan C.; And Others

    1984-01-01

    In response to the perceived need for primary care physicians, two major changes in internal medicine training have occurred: (1) a third year of general training was required for internal medicine board certification and (2) many hospitals developed primary care internal medicine residencies with an increased emphasis on ambulatory training.…

  8. Residency programs and the outlook for occupational and environmental medicine in Korea.

    Science.gov (United States)

    Lee, Youngil; Kim, Jungwon; Chae, Yoomi

    2015-01-01

    This study investigated the implementation of training courses and the overall outlook for occupational and environmental medicine (OEM) in Korea. We described the problems facing OEM residency programs in Korea, and reviewed studies dealing with the specialty of occupational health in developed countries in order to suggest directions of improvement for the OEM training courses. We surveyed 125 OEM residents using a questionnaire in August 2012. A total of 23 questions about the training environment, residency programs, preferred institutions for post-licensure employment, and the outlook for OEM specialists were included in the questionnaire and analyzed according to the type of training institution and residency year. Responses from 88 residents (70.4 %) were analyzed. The major responsibilities of OEM residents were found to vary depending on whether they were trained in research institutes or in hospitals. OEM residents had a lower level of satisfaction with the following training programs: toxicology practice (measurements of biological markers, metabolites, and working environments), and OEM practice (environmental diseases and clinical training involving surgery). When asked about their eventual place of employment, OEM residents preferred institutions providing special health examinations or health management services. OEM residents reported a positive outlook for OEM over the next 5 years, but a negative outlook for the next 10 years. Although a standardized training curriculum for OEM residents exists, this study found differences in the actual training courses depending on the training institution. We plan to standardize OEM training by holding a regional conference and introducing open training methods, such as an open hospital system. Use of Korean-language OEM textbook may also reduce differences in the educational programs of each training institution. Toxicology practice, environmental diseases, and clinical training in surgery are areas that

  9. Residents as teachers: psychiatry and family medicine residents' self-assessment of teaching knowledge, skills, and attitudes.

    Science.gov (United States)

    Brand, Michael W; Ekambaram, Vijayabharathi; Tucker, Phebe; Aggarwal, Ruchi

    2013-09-01

    Residents are one of the prime sources of information and education for medical students. As an initial step in supporting residents as teachers, a baseline self-assessment of residents' knowledge, skills, attitudes, and values related to teaching was conducted among psychiatry and family medicine residents to compare and improve their confidence and skills as teachers. Psychiatry residents (N=12) and family medicine residents (N=23) completed self-assessments of their knowledge, skills, attitudes, and values related to teaching. Residents also were asked to list steps used in the One-Minute Preceptor process and estimate the time each spent in teaching. Descriptive summary statistics were used for four main areas related to teaching; t-test and chi-square analyses were conducted to ascertain whether there was a significant difference in resident groups. In the current study, the perceived amount of time spent for teaching patients was significantly higher among family practice residents, whereas no group differences were found for time teaching medical students, peers, community members, non-physicians, or others. However, family medicine residents rated themselves higher than psychiatry residents in their understanding of their roles in teaching medical students and teaching patients. Also, family medicine residents' self-reported teaching skills were more advanced (82.4%) than psychiatry residents' (54.2%). They most likely applied at least two different teaching methods in inpatient and outpatient settings, as compared with psychiatry residents. No significant group differences were found in the other 15 items assessing teaching knowledge, skills, attitudes, and values. Results indicate that residents' knowledge, skills, attitudes, and values regarding teaching varies across institutions and training programs. The psychiatry residents in this study do not clearly understand their role as educators with patients and medical students; they have a less clear

  10. [Part-time residency training in Israel].

    Science.gov (United States)

    Fishbain, Dana; Levi, Baruch; Borow, Malke; Ashkenazi, Shai; Lindner, Arie

    2012-08-01

    Full-time work has long been perceived as a cornerstone of medical residency, the consensus being that a resident must apply the bulk of his time and attention to his professional training. Demographic and cultural changes that have taken place over the last several years, specifically the rise in the number of female doctors and the importance of leisure time to the younger generation, have intensified the need to find new and innovative ways to deal with the plight of the resident population. One idea, already in effect in many Western countries, is the institution of part-time residency programs. The possibility of fulfilling residency requirements on a part-time basis is intended to assist medical residents in integrating their professional development with their personal and family life, without compromising the quality of their training. A number of research studies conducted over the last several years in countries that allow part-time residency, among them the United States, England and Switzerland, aimed to examine the quality of part-time training. The various studies evinced a high level of satisfaction from the program both by the residents themselves and their supervisors, and in many aspects those doing residency part-time received higher appraisals than their full-time colleagues. Some of the residents polled noted that they would have totally foregone the practice of medicine had there not been an option to complete residency part-time. In light of the experience throughout the world and the changing landscape in Israel, the Scientific Council of the Israeli Medical Association decided to examine the issue and its various aspects, and weighed all the considerations in favor and against part-time residency. Recently, the Scientific Council approved the launch of a pilot program to allow part-time residency in several fields that were carefully selected according to specific criteria. Once the Ministry of Health completes the LegisLation process, part

  11. Electrodiagnostic medicine skills competency in physical medicine and rehabilitation residents: a method for development and assessment.

    Science.gov (United States)

    Brown, David; Cuccurullo, Sara; Lee, Joseph; Petagna, Ann; Strax, Thomas

    2008-08-01

    This project sought to create an educational module including evaluation methodology to instruct physical medicine and rehabilitation (PM&R) residents in electrodiagnostic evaluation of patients with neuromuscular problems, and to verify acquired competencies in those electrodiagnostic skills through objective evaluation methodology. Sixteen residents were trained by board-certified neuromuscular and electrodiagnostic medicine physicians through technical training, lectures, and review of self-assessment examination (SAE) concepts from the American Academy of Physical Medicine & Rehabilitation syllabus provided in the Archives of Physical Medicine and Rehabilitation. After delivery of the educational module, knowledge acquisition and skill attainment were measured in (1) clinical skill in diagnostic procedures via a procedure checklist, (2) diagnosis and ability to design a patient-care management plan via chart simulated recall (CSR) exams, (3) physician/patient interaction via patient surveys, (4) physician/staff interaction via 360-degree global ratings, and (5) ability to write a comprehensive patient-care report and to document a patient-care management plan in accordance with Medicare guidelines via written patient reports. Assessment tools developed for this program address the basic competencies outlined by the Accreditation Council for Graduate Medical Education (ACGME). To test the success of the standardized educational module, data were collected on an ongoing basis. Objective measures compared resident SAE scores in electrodiagnostics (EDX) before and after institution of the comprehensive EDX competency module in a PM&R residency program. Fifteen of 16 residents (94%) successfully demonstrated proficiency in every segment of the evaluation element of the educational module by the end of their PGY-4 electrodiagnostic rotation. The resident who did not initially pass underwent remedial coursework and passed on the second attempt. Furthermore, the

  12. Teambuilding and leadership training in an internal medicine residency training program.

    Science.gov (United States)

    Stoller, James K; Rose, Mark; Lee, Rita; Dolgan, Colleen; Hoogwerf, Byron J

    2004-06-01

    The purpose of this report is to describe and evaluate the impact of a 1-day retreat focused on developing leadership skills and teambuilding among postgraduate year 1 residents in an internal medicine residency. A group of organizers, including members of the staff, the chief medical residents, administrative individuals in the residency office, and an internal organizational development consultant convened to organize an off-site retreat with activities that would provide experiential learning regarding teamwork and leadership, including a "reef survival exercise" and table discussions regarding the characteristics of ideal leaders. In addition, several energizing activities and recreational free time was provided to enhance the interaction and teamwork dimensions of the retreat. To evaluate the impact of the retreat, attendees completed baseline and follow-up questionnaires regarding their experience of the retreat. Attendees universally regarded the retreat as having value for them. Comparison of baseline to postretreat responses indicated that attendees felt that the retreat enhanced their abilities to be better physicians, resident supervisors, and leaders. Follow-up responses indicated significant increases in attendees' agreement that good leaders challenge the process, make decisions based on shared visions, allow others to act, recognize individual contributions, and serve as good role models. Results on the survival exercise indicated a high frequency with which team-based decisions surpassed individual members' decisions, highlighting the importance and value of teamwork to attendees. Our main findings were that: participants universally found this 1-day retreat beneficial in helping to develop teamwork and leadership skills and the experiential learning aspects of the retreat were more especially highly rated and highlighted the advantages of teamwork. In the context that this 1-day retreat was deemed useful by faculty and residents alike, further

  13. Teambuilding and Leadership Training in an Internal Medicine Residency Training Program

    Science.gov (United States)

    Stoller, James K; Rose, Mark; Lee, Rita; Dolgan, Colleen; Hoogwerf, Byron J

    2004-01-01

    OBJECTIVE The purpose of this report is to describe and evaluate the impact of a 1-day retreat focused on developing leadership skills and teambuilding among postgraduate year 1 residents in an internal medicine residency. METHOD A group of organizers, including members of the staff, the chief medical residents, administrative individuals in the residency office, and an internal organizational development consultant convened to organize an off-site retreat with activities that would provide experiential learning regarding teamwork and leadership, including a “reef survival exercise” and table discussions regarding the characteristics of ideal leaders. In addition, several energizing activities and recreational free time was provided to enhance the interaction and teamwork dimensions of the retreat. To evaluate the impact of the retreat, attendees completed baseline and follow-up questionnaires regarding their experience of the retreat. RESULTS Attendees universally regarded the retreat as having value for them. Comparison of baseline to postretreat responses indicated that attendees felt that the retreat enhanced their abilities to be better physicians, resident supervisors, and leaders. Follow-up responses indicated significant increases in attendees’ agreement that good leaders challenge the process, make decisions based on shared visions, allow others to act, recognize individual contributions, and serve as good role models. Results on the survival exercise indicated a high frequency with which team-based decisions surpassed individual members’ decisions, highlighting the importance and value of teamwork to attendees. CONCLUSIONS Our main findings were that: participants universally found this 1-day retreat beneficial in helping to develop teamwork and leadership skills and the experiential learning aspects of the retreat were more especially highly rated and highlighted the advantages of teamwork. In the context that this 1-day retreat was deemed useful

  14. Internal Medicine Residents' Perceived Responsibility for Patients at Hospital Discharge: A National Survey.

    Science.gov (United States)

    Young, Eric; Stickrath, Chad; McNulty, Monica C; Calderon, Aaron J; Chapman, Elizabeth; Gonzalo, Jed D; Kuperman, Ethan F; Lopez, Max; Smith, Christopher J; Sweigart, Joseph R; Theobald, Cecelia N; Burke, Robert E

    2016-12-01

    Medical residents are routinely entrusted with transitions of care, yet little is known about the duration or content of their perceived responsibility for patients they discharge from the hospital. To examine the duration and content of internal medicine residents' perceived responsibility for patients they discharge from the hospital. The secondary objective was to determine whether specific individual experiences and characteristics correlate with perceived responsibility. Multi-site, cross-sectional 24-question survey delivered via email or paper-based form. Internal medicine residents (post-graduate years 1-3) at nine university and community-based internal medicine training programs in the United States. Perceived responsibility for patients after discharge as measured by a previously developed single-item tool for duration of responsibility and novel domain-specific questions assessing attitudes towards specific transition of care behaviors. Of 817 residents surveyed, 469 responded (57.4 %). One quarter of residents (26.1 %) indicated that their responsibility for patients ended at discharge, while 19.3 % reported perceived responsibility extending beyond 2 weeks. Perceived duration of responsibility did not correlate with level of training (P = 0.57), program type (P = 0.28), career path (P = 0.12), or presence of burnout (P = 0.59). The majority of residents indicated they were responsible for six of eight transitional care tasks (85.1-99.3 % strongly agree or agree). Approximately half of residents (57 %) indicated that it was their responsibility to directly contact patients' primary care providers at discharge. and 21.6 % indicated that it was their responsibility to ensure that patients attended their follow-up appointments. Internal medicine residents demonstrate variability in perceived duration of responsibility for recently discharged patients. Neither the duration nor the content of residents' perceived responsibility was

  15. Leadership and business education in orthopaedic residency training programs.

    Science.gov (United States)

    Kiesau, Carter D; Heim, Kathryn A; Parekh, Selene G

    2011-01-01

    Leadership and business challenges have become increasingly present in the practice of medicine. Orthopaedic residency programs are at the forefront of educating and preparing orthopaedic surgeons. This study attempts to quantify the number of orthopaedic residency programs in the United States that include leadership or business topics in resident education program and to determine which topics are being taught and rate the importance of various leadership characteristics and business topics. A survey was sent to all orthopaedic department chairpersons and residency program directors in the United States via e-mail. The survey responses were collected using a survey collection website. The respondents rated the importance of leadership training for residents as somewhat important. The quality of character, integrity, and honesty received the highest average rating among 19 different qualities of good leaders in orthopaedics. The inclusion of business training in resident education was also rated as somewhat important. The topic of billing and coding received the highest average rating among 14 different orthopaedically relevant business topics. A variety of topics beyond the scope of clinical practice must be included in orthopaedic residency educational curricula. The decreased participation of newly trained orthopaedic surgeons in leadership positions and national and state orthopaedic organizations is concerning for the future of orthopaedic surgery. Increased inclusion of leadership and business training in resident education is important to better prepare trainees for the future.

  16. Keeping up with the times: revising the dermatology residency curriculum in the era of molecular diagnostics and personalized medicine.

    Science.gov (United States)

    LaChance, Avery; Murphy, Michael J

    2014-11-01

    The clinical use of molecular diagnostics, genomics, and personalized medicine is increasing and improving rapidly over time. However, medical education incorporating the practical application of these techniques is lagging behind. Although instruction in these areas should be expanded upon and improved at all levels of training, residency provides a concentrated period of time in which to hone in on skills that are practically applicable to a trainee's specialty of choice. Although residencies in some fields, such as pathology, have begun to incorporate practical molecular diagnostics training, this area remains a relative gap in dermatology residency programs. Herein, we advocate for the incorporation of training in molecular diagnostics and personalized medicine into dermatology residency programs and propose a basic curriculum template for how to begin approaching these topics. By incorporating molecular diagnostics into dermatology residency training, dermatologists have the opportunity to lead the way and actively shape the specialty's transition into the era of personalized medicine. © 2014 The International Society of Dermatology.

  17. Examining Critical Thinking Skills in Family Medicine Residents.

    Science.gov (United States)

    Ross, David; Schipper, Shirley; Westbury, Chris; Linh Banh, Hoan; Loeffler, Kim; Allan, G Michael; Ross, Shelley

    2016-02-01

    Our objective was to determine the relationship between critical thinking skills and objective measures of academic success in a family medicine residency program. This prospective observational cohort study was set in a large Canadian family medicine residency program. Intervention was the California Critical Thinking Skills Test (CCTST), administered at three points in residency: upon entry, at mid-point, and at graduation. Results from the CCTST, Canadian Residency Matching Service file, and interview scores were compared to other measures of academic performance (Medical Colleges Admission Test [MCAT] and College of Family Physicians of Canada [CCFP] certification examination results). For participants (n=60), significant positive correlations were found between critical thinking skills and performance on tests of knowledge. For the MCAT, CCTST scores correlated positively with full scores (n=24, r=0.57) as well as with each section score (verbal reasoning: r=0.59; physical sciences: r=0.64; biological sciences: r=0.54). For CCFP examination, CCTST correlated reliably with both sections (n=49, orals: r=0.34; short answer: r=0.47). Additionally, CCTST was a better predictor of performance on the CCFP exam than was the interview score at selection into the residency program (Fisher's r-to-z test, z=2.25). Success on a critical thinking skills exam was found to predict success on family medicine certification examinations. Given that critical thinking skills appear to be stable throughout residency training, including an assessment of critical thinking in the selection process may help identify applicants more likely to be successful on final certification exam.

  18. Development of a novel sports medicine rotation for emergency medicine residents

    Directory of Open Access Journals (Sweden)

    Waterbrook AL

    2016-04-01

    Full Text Available Anna L Waterbrook,1 T Gail Pritchard,2 Allison D Lane,1 Lisa R Stoneking,1 Bryna Koch,2 Robert McAtee,1 Kristi H Grall,1 Alice A Min,1 Jessica Prior,1 Isaac Farrell,1 Holly G McNulty,1 Uwe Stolz1 1Department of Emergency Medicine, 2Office of Medical Student Education, The University of Arizona, Tucson, AZ, USA Abstract: Musculoskeletal complaints are the most common reason for patients to visit a physician, yet competency in musculoskeletal medicine is invariably reported as a deficiency in medical education in the USA. Sports medicine clinical rotations improve both medical students' and residents' musculoskeletal knowledge. Despite the importance of this knowledge, a standardized sports medicine curriculum in emergency medicine (EM does not exist. Hence, we developed a novel sports medicine rotation for EM residents to improve their musculoskeletal educational experience and to improve their knowledge in musculoskeletal medicine by teaching the evaluation and management of many common musculoskeletal disorders and injuries that are encountered in the emergency department. The University of Arizona has two distinct EM residency programs, South Campus (SC and University Campus (UC. The UC curriculum includes a traditional 4-week orthopedic rotation, which consistently rated poorly on evaluations by residents. Therefore, with the initiation of a new EM residency at SC, we replaced the standard orthopedic rotation with a novel sports medicine rotation for EM interns. This rotation includes attendance at sports medicine clinics with primary care and orthopedic sports medicine physicians, involvement in sport event coverage, assigned reading materials, didactic experiences, and an on-call schedule to assist with reductions in the emergency department. We analyzed postrotation surveys completed by residents, postrotation evaluations of the residents completed by primary care sports medicine faculty and orthopedic chief residents, as well as the

  19. Re-engineering the nuclear medicine residency curriculum in the new era of PET imaging: Perspectives on PET education and training in the Philippine context

    International Nuclear Information System (INIS)

    Pascual, T.N.; Santiago, J.F.; Leus, M.

    2007-01-01

    Full text: There is rapid development in PET Imaging and Molecular Nuclear Medicine. In the context of a residency training program, there is a need to incorporate these technologies in the existing Nuclear Medicine Residency Training Curriculum. This will ensure that trainees are constantly updated with the latest innovations in Nuclear Medicine making them apply this progress in their future practice hence making them achieve the goals and objectives of the curriculum. In residency training programs wherein no PET facilities are existing, these may be remedied by re-engineering the curriculum to include mandatory /electives rotations to other hospitals where the facilities are available. In order to ensure the integrity of the training program in this process of development, a proper sequence of this re-engineering process adhering to educational principles is suggested. These steps reflect the adoption of innovations and developments in the field of Nuclear Medicine essential for nuclear medicine resident learning. Curriculum re-engineering is a scientific and logical method reflecting the processes of addressing changes in the curriculum in order to deliver the desired goals and objectives of the program as dictated by time and innovations. The essential steps in this curriculum re-engineering process, which in this case aim to incorporate and/or update PET Imaging and Molecular Nuclear Imaging education and training, include (1) Curriculum Conceptualization and Legitimatisation, (2) Curriculum Diagnosis, (3) Curriculum Engineering, Designing and Organization, (4) Curriculum Implementation, (5) Curriculum Evaluation, (6) Curriculum Maintenance and (7) Curriculum Re-engineering. All of these sequences consider the participation of the different stakeholders of the training program. They help develop the curriculum, which seeks to promote student learning according to the dictates of the goals and objectives of the program and technology development. Once the

  20. Factors associated with the subspecialty choices of internal medicine residents in Canada.

    Science.gov (United States)

    Horn, Leora; Tzanetos, Katina; Thorpe, Kevin; Straus, Sharon E

    2008-06-26

    Currently, there are more residents enrolled in cardiology training programs in Canada than in immunology, pharmacology, rheumatology, infectious diseases, geriatrics and endocrinology combined. There is no published data regarding the proportion of Canadian internal medicine residents applying to the various subspecialties, or the factors that residents consider important when deciding which subspecialty to pursue. To address the concern about physician imbalances in internal medicine subspecialties, we need to examine the factors that motivate residents when making career decisions. In this two-phase study, Canadian internal medicine residents participating in the post graduate year 4 (PGY4) subspecialty match were invited to participate in a web-based survey and focus group discussions. The focus group discussions were based on issues identified from the survey results. Analysis of focus group transcripts grew on grounded theory. 110 PGY3 residents participating in the PGY4 subspecialty match from 10 participating Canadian universities participated in the web-based survey (54% response rate). 22 residents from 3 different training programs participated in 4 focus groups held across Canada. Our study found that residents are choosing careers that provide intellectual stimulation, are consistent with their personality, and that provide a challenge in diagnosis. From our focus group discussions it appears that lifestyle, role models, mentorship and the experience of the resident with the specialty appear to be equally important in career decisions. Males are more likely to choose procedure based specialties and are more concerned with the reputation of the specialty as well as the anticipated salary. In contrast, residents choosing non-procedure based specialties are more concerned with issues related to lifestyle, including work-related stress, work hours and time for leisure as well as the patient populations they are treating. This study suggests that internal

  1. Factors associated with the subspecialty choices of internal medicine residents in Canada

    Directory of Open Access Journals (Sweden)

    Thorpe Kevin

    2008-06-01

    Full Text Available Abstract Background Currently, there are more residents enrolled in cardiology training programs in Canada than in immunology, pharmacology, rheumatology, infectious diseases, geriatrics and endocrinology combined. There is no published data regarding the proportion of Canadian internal medicine residents applying to the various subspecialties, or the factors that residents consider important when deciding which subspecialty to pursue. To address the concern about physician imbalances in internal medicine subspecialties, we need to examine the factors that motivate residents when making career decisions. Methods In this two-phase study, Canadian internal medicine residents participating in the post graduate year 4 (PGY4 subspecialty match were invited to participate in a web-based survey and focus group discussions. The focus group discussions were based on issues identified from the survey results. Analysis of focus group transcripts grew on grounded theory. Results 110 PGY3 residents participating in the PGY4 subspecialty match from 10 participating Canadian universities participated in the web-based survey (54% response rate. 22 residents from 3 different training programs participated in 4 focus groups held across Canada. Our study found that residents are choosing careers that provide intellectual stimulation, are consistent with their personality, and that provide a challenge in diagnosis. From our focus group discussions it appears that lifestyle, role models, mentorship and the experience of the resident with the specialty appear to be equally important in career decisions. Males are more likely to choose procedure based specialties and are more concerned with the reputation of the specialty as well as the anticipated salary. In contrast, residents choosing non-procedure based specialties are more concerned with issues related to lifestyle, including work-related stress, work hours and time for leisure as well as the patient populations

  2. Benchmarks for Support and Outcomes for Internal Medicine-Pediatrics Residency Programs: A 5-Year Review

    Science.gov (United States)

    Aronica, Michael; Williams, Ronald; Dennar, Princess E.; Hopkins, Robert H.

    2015-01-01

    Background Combined internal medicine and pediatrics (medicine-pediatrics) residencies were Accreditation Council for Graduate Medical Education (ACGME) accredited separately from their corresponding categorical residencies in June 2006. Objective We investigated how ACGME accreditation of medicine-pediatrics programs has affected the levels of support (both financial and personnel), the National Resident Matching Program (NRMP) match rate, performance on the board examination, and other graduate outcomes. Methods From 2009 through 2013 we sent an annual SurveyMonkey online survey to members of the Medicine-Pediatrics Program Directors Association. Questions pertained to program characteristics, program director support, recruitment, ambulatory training, and graduate data. More than 79% of responders completed the entire survey for each year (sample size was 60 program directors). Results Compared to the time prior to accreditation of the specialty, there was an increase in program directors who are dually trained (89% versus 93%), an increase in program director salary ($134,000 before accreditation versus $185,000 in 2013, P medicine. Conclusions Our data show widespread improved support for medicine-pediatrics programs since the 2006 start of ACGME accreditation. PMID:26692969

  3. Factors that influence medical student selection of an emergency medicine residency program: implications for training programs.

    Science.gov (United States)

    Love, Jeffrey N; Howell, John M; Hegarty, Cullen B; McLaughlin, Steven A; Coates, Wendy C; Hopson, Laura R; Hern, Gene H; Rosen, Carlo L; Fisher, Jonathan; Santen, Sally A

    2012-04-01

    An understanding of student decision-making when selecting an emergency medicine (EM) training program is essential for program directors as they enter interview season. To build upon preexisting knowledge, a survey was created to identify and prioritize the factors influencing candidate decision-making of U.S. medical graduates. This was a cross-sectional, multi-institutional study that anonymously surveyed U.S. allopathic applicants to EM training programs. It took place in the 3-week period between the 2011 National Residency Matching Program (NRMP) rank list submission deadline and the announcement of match results. Of 1,525 invitations to participate, 870 candidates (57%) completed the survey. Overall, 96% of respondents stated that both geographic location and individual program characteristics were important to decision-making, with approximately equal numbers favoring location when compared to those who favored program characteristics. The most important factors in this regard were preference for a particular geographic location (74.9%, 95% confidence interval [CI] = 72% to 78%) and to be close to spouse, significant other, or family (59.7%, 95% CI = 56% to 63%). Factors pertaining to geographic location tend to be out of the control of the program leadership. The most important program factors include the interview experience (48.9%, 95% CI = 46% to 52%), personal experience with the residents (48.5%, 95% CI = 45% to 52%), and academic reputation (44.9%, 95% CI = 42% to 48%). Unlike location, individual program factors are often either directly or somewhat under the control of the program leadership. Several other factors were ranked as the most important factor a disproportionate number of times, including a rotation in that emergency department (ED), orientation (academic vs. community), and duration of training (3-year vs. 4-year programs). For a subset of applicants, these factors had particular importance in overall decision-making. The vast majority

  4. Executive Summary from the 2017 Emergency Medicine Resident Wellness Consensus Summit.

    Science.gov (United States)

    Battaglioli, Nicole; Ankel, Felix; Doty, Christopher I; Chung, Arlene; Lin, Michelle

    2018-03-01

    Physician wellness has recently become a popular topic of conversation and publication within the house of medicine and specifically within emergency medicine (EM). Through a joint collaboration involving Academic Life in Emergency Medicine's (ALiEM) Wellness Think Tank, Essentials of Emergency Medicine (EEM), and the Emergency Medicine Residents' Association (EMRA), a one-day Resident Wellness Consensus Summit (RWCS) was organized. The RWCS was held on May 15, 2017, as a pre-day event prior to the 2017 EEM conference in Las Vegas, Nevada. Seven months before the RWCS event, pre-work began in the ALiEM Wellness Think Tank, which was launched in October 2016. The Wellness Think Tank is a virtual community of practice involving EM residents from the U.S. and Canada, hosted on the Slack digital-messaging platform. A working group was formed for each of the four predetermined themes: wellness curriculum development; educator toolkit resources for specific wellness topics; programmatic innovations; and wellness-targeted technologies. Pre-work for RWCS included 142 residents from 100 different training programs in the Wellness Think Tank. Participants in the actual RWCS event included 44 EM residents, five EM attendings who participated as facilitators, and three EM attendings who acted as participants. The four working groups ultimately reached a consensus on their specific objectives to improve resident wellness on both the individual and program level. The Resident Wellness Consensus Summit was a unique and novel consensus meeting, involving residents as the primary stakeholders. The summit demonstrated that it is possible to galvanize a large group of stakeholders in a relatively short time by creating robust trust, communication, and online learning networks to create resources that support resident wellness.

  5. Burnout and Physical Activity in Minnesota Internal Medicine Resident Physicians

    Science.gov (United States)

    Olson, Shawn M.; Odo, Nnaemeka U.; Duran, Alisa M.; Pereira, Anne G.; Mandel, Jeffrey H.

    2014-01-01

    Background Regular physical activity plays an important role in the amelioration of several mental health disorders; however, its relationship with burnout has not yet been clarified. Objective To determine the association between achievement of national physical activity guidelines and burnout in internal medicine resident physicians. Methods A Web-based survey of internal medicine resident physicians at the University of Minnesota and Hennepin County Medical Center was conducted from September to October 2012. Survey measures included the Maslach Burnout Inventory-Human Services Survey and the International Physical Activity Questionnaire. Results Of 149 eligible residents, 76 (51.0%) completed surveys, which were used in the analysis. Burnout prevalence, determined by the Maslach Burnout Inventory, was 53.9% (41 of 76). Prevalence of failure to achieve US Department of Health and Human Services physical activity guidelines was 40.8% (31 of 76), and 78.9% (60 of 76) of residents reported that their level of physical activity has decreased since they began medical training. Residents who were able to meet physical activity guidelines were less likely to be burned out than their fellow residents (OR, 0.38, 95% CI 0.147–0.99). Conclusions Among internal medicine resident physicians, achievement of national physical activity guidelines appears to be inversely associated with burnout. Given the high national prevalence of burnout and inactivity, additional investigation of this relationship appears warranted. PMID:26140116

  6. The hospital educational environment and performance of residents in the General Medicine In-Training Examination: a multicenter study in Japan

    Directory of Open Access Journals (Sweden)

    Shimizu T

    2013-07-01

    Full Text Available Taro Shimizu,1 Yusuke Tsugawa,2,3 Yusuke Tanoue,4 Ryota Konishi,5 Yuji Nishizaki,6 Mitsumasa Kishimoto,7 Toshiaki Shiojiri,8 Yasuharu Tokuda9 1Hospitalist Division, Department of Medicine, Nerima Hikarigaoka Hospital, Tokyo, Japan; 2Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; 3Center for Clinical Epidemiology, St Luke's Life Science Institute, 4Department of Vascular and Oncological Surgery, Hospital of Tokyo University, 5Department of General Internal Medicine, Kanto Rousai Hospital, 6Department of Cardiology, Juntendo University School of Medicine, 7Division of Rheumatology, St Luke's International Hospital, Tokyo, Japan; 8Asahi Chuo Hospital, Chiba, Japan; 9Department of Medicine, Tsukuba University Mito Kyodo General Hospital, Mito City, Ibaraki, Japan Background: It is believed that the type of educational environment in teaching hospitals may affect the performance of medical knowledge base among residents, but this has not yet been proven. Objective: We aimed to investigate the association between the hospital educational environment and the performance of the medical knowledge base among resident physicians in Japanese teaching hospitals. Methods: To assess the knowledge base of medicine, we conducted the General Medicine In-Training Examination (GM-ITE for second-year residents in the last month of their residency. The items of the exam were developed based on the outcomes designated by the Japanese Ministry of Health, Labor, and Welfare. The educational environment was evaluated using the Postgraduate Hospital Educational Environment Measure (PHEEM score, which was assessed by a mailed survey 2 years prior to the exam. A mixed-effects linear regression model was employed for the analysis of variables associated with a higher score. Results: Twenty-one teaching hospitals participated in the study and a total of 206 residents (67 women participated and

  7. NON-MUSCULOSKELETAL SPORTS MEDICINE LEARNING IN FAMILY MEDICINE RESIDENCY PROGRAMS

    Directory of Open Access Journals (Sweden)

    Pasqualino Caputo

    2008-06-01

    Full Text Available Despite the increasing popularity of primary care sports medicine fellowships, as evidenced by the more than two-fold increase in family medicine sports medicine fellowships from a total of 31 accredited programs during the 1998/1999 academic year (ACGME, 1998 to 63 during the 2003/2004 academic year (ACGME, 2006, there are few empirical studies to support the efficacy of such programs. To the best of our knowledge, no studies have been conducted to assess the impact of primary care sports medicine fellowships on family medicine residents' learning of non-musculoskeletal sports medicine topics. Rigorous evaluations of the outcomes of such programs are helpful to document the value of such programs to both the lay public and interested medical residents. In order to evaluate such programs, it is helpful to apply the same objective standards to residents trained across multiple programs. Hence, we would like to know if there is a learning effect with respect to non-musculoskeletal sports medicine topics identified on yearly administered American Board of Family Medicine (ABFM in-training exams (ITE to family medicine residents in family medicine residency programs in the United States with and without primary care sports medicine fellowship programs. Review and approval for the research proposal was granted by the ABFM, who also allowed access to the required data. Permission to study and report only non-musculoskeletal sports medicine topics excluding musculoskeletal topics was granted at the time due to other ongoing projects at the ABFM involving musculoskeletal topics. ABFM allowed us access to examinations from 1998 to 2003. We were given copies of each exam and records of responses to each item (correct or incorrect by each examinee (examinees were anonymous for each year.For each year, each examinee was classified by the ABFM as either (a belonging to a program that contained a sports medicine fellowship, or (b not belonging to a program

  8. Impact of Pregnancy and Gender on Internal Medicine Resident Evaluations: A Retrospective Cohort Study.

    Science.gov (United States)

    Krause, Megan L; Elrashidi, Muhamad Y; Halvorsen, Andrew J; McDonald, Furman S; Oxentenko, Amy S

    2017-06-01

    Pregnancy and its impact on graduate medical training are not well understood. To examine the effect of gender and pregnancy for Internal Medicine (IM) residents on evaluations by peers and faculty. This was a retrospective cohort study. All IM residents in training from July 1, 2004-June 30, 2014, were included. Female residents who experienced pregnancy and male residents whose partners experienced pregnancy during training were identified using an existing administrative database. Mean evaluation scores by faculty and peers were compared relative to pregnancy (before, during, and after), accounting for the gender of both the evaluator and resident in addition to other available demographic covariates. Potential associations were assessed using mixed linear models. Of 566 residents, 117 (20.7%) experienced pregnancy during IM residency training. Pregnancy was more common in partners of male residents (24.7%) than female residents (13.2%) (p = 0.002). In the post-partum period, female residents had lower peer evaluation scores on average than their male counterparts (p = 0.0099). A large number of residents experience pregnancy during residency. Mean peer evaluation scores were lower after pregnancy for female residents. Further study is needed to fully understand the mechanisms behind these findings, develop ways to optimize training throughout pregnancy, and explore any unconscious biases that may exist.

  9. Are Self-study Procedural Teaching Methods Effective? A Pilot Study of a Family Medicine Residency Program.

    Science.gov (United States)

    Deffenbacher, Brandy; Langner, Shannon; Khodaee, Morteza

    2017-11-01

    A family medicine residency is a unique training environment where residents are exposed to care in multiple settings, across all ages. Procedures are an integral part of family medicine practice. Family medicine residency (FMR) programs are tasked with the job of teaching these skills at a level of intensity and frequency that allows a resident to achieve competency of such skills. In an environment that is limited by work hour restrictions, self-study teaching methods are one way to ensure all residents receive the fundamental knowledge of how to perform procedures. We developed and evaluated the efficacy of a self-study procedure teaching method and procedure evaluation checklist. A self-study procedure teaching intervention was created, consisting of instructional articles and videos on three procedures. To assess the efficacy of the intervention, and the competency of the residents, pre- and postintervention procedure performance sessions were completed. These sessions were reviewed and scored using a standardized procedure performance checklist. All 24 residents participated in the study. Overall, the resident procedure knowledge increased on two of the three procedures studied, and ability to perform procedure according to expert-validated checklist improved significantly on all procedures. A self-study intervention is a simple but effective way to increase and improve procedure training in a way that fits the complex scheduling needs of a residency training program. In addition, this study demonstrates that the procedure performance checklists are a simple and reliable way to increase assessment of resident procedure performance skills in a residency setting.

  10. Career interest and perceptions of nephrology: A repeated cross-sectional survey of internal medicine residents.

    Science.gov (United States)

    Daniels, Michael N; Maynard, Sharon; Porter, Ivan; Kincaid, Hope; Jain, Deepika; Aslam, Nabeel

    2017-01-01

    Interest in nephrology careers among internal medicine residents in the United States is declining. Our objective was to assess the impact of the presence of a nephrology fellowship training program on perceptions and career interest in nephrology among internal medicine residents. A secondary objective was to identify commonly endorsed negative perceptions of nephrology among internal medicine residents. This was a repeated cross-sectional survey of internal medicine residents before (Group 1) and 3 years after (Group 2) the establishment of nephrology fellowship programs at two institutions. The primary outcome was the percentage of residents indicating nephrology as a career interest in Group 1 vs. Group 2. Secondary outcomes included the frequency that residents agreed with negative statements about nephrology. 131 (80.9%) of 162 residents completed the survey. 19 (14.8%) residents indicated interest in a nephrology career, with 8 (6.3%) indicating nephrology as their first choice. There was no difference in career interest in nephrology between residents who were exposed to nephrology fellows during residency training (Group 2) and residents who were not (Group 1). The most commonly endorsed negative perceptions of nephrology were: nephrology fellows have long hours/burdensome call (36 [28.1%] of residents agreed or strongly agreed), practicing nephrologists must take frequent/difficult call (35 [27.6%] agreed or strongly agreed), and nephrology has few opportunities for procedures (35 [27.3%] agreed or strongly agreed). More residents in Group 2 agreed that nephrology is poorly paid (8.9% in Group 1 vs. 20.8% in Group 2, P = 0.04), whereas more residents in Group 1 agreed that nephrologists must take frequent/difficult call (40.0% in Group 1 vs. 18.1% in Group 2, P = 0.02). The initiation of a nephrology fellowship program was not associated with an increase in internal medicine residents' interest in nephrology careers. Residents endorsed several negative

  11. Career interest and perceptions of nephrology: A repeated cross-sectional survey of internal medicine residents.

    Directory of Open Access Journals (Sweden)

    Michael N Daniels

    Full Text Available Interest in nephrology careers among internal medicine residents in the United States is declining. Our objective was to assess the impact of the presence of a nephrology fellowship training program on perceptions and career interest in nephrology among internal medicine residents. A secondary objective was to identify commonly endorsed negative perceptions of nephrology among internal medicine residents.This was a repeated cross-sectional survey of internal medicine residents before (Group 1 and 3 years after (Group 2 the establishment of nephrology fellowship programs at two institutions. The primary outcome was the percentage of residents indicating nephrology as a career interest in Group 1 vs. Group 2. Secondary outcomes included the frequency that residents agreed with negative statements about nephrology.131 (80.9% of 162 residents completed the survey. 19 (14.8% residents indicated interest in a nephrology career, with 8 (6.3% indicating nephrology as their first choice. There was no difference in career interest in nephrology between residents who were exposed to nephrology fellows during residency training (Group 2 and residents who were not (Group 1. The most commonly endorsed negative perceptions of nephrology were: nephrology fellows have long hours/burdensome call (36 [28.1%] of residents agreed or strongly agreed, practicing nephrologists must take frequent/difficult call (35 [27.6%] agreed or strongly agreed, and nephrology has few opportunities for procedures (35 [27.3%] agreed or strongly agreed. More residents in Group 2 agreed that nephrology is poorly paid (8.9% in Group 1 vs. 20.8% in Group 2, P = 0.04, whereas more residents in Group 1 agreed that nephrologists must take frequent/difficult call (40.0% in Group 1 vs. 18.1% in Group 2, P = 0.02.The initiation of a nephrology fellowship program was not associated with an increase in internal medicine residents' interest in nephrology careers. Residents endorsed several

  12. Military Internal Medicine Resident Decision to Apply to Fellowship and Extend Military Commitment.

    Science.gov (United States)

    Barsoumian, Alice E; Hartzell, Joshua D; Bonura, Erin M; Ressner, Roseanne A; Whitman, Timothy J; Yun, Heather C

    2018-02-06

    Nationally, the number of internal medicine physicians practicing in primary care has decreased amidst increasing interest in hospitalist medicine. Current priorities in the Military Health System include access to primary care and retention of trained personnel. Recently, we have conducted a study of military internal medicine residents' decision to enter infectious disease. As part of our larger effort, we saw an opportunity to characterize factors impacting decision making of internal medicine residents' desire to apply for subspecialty training and to extend active duty service obligations. Questions were developed after discussion with various military graduate medical education and internal medicine leaders, underwent external review, and were added to a larger question set. The survey link was distributed electronically to all U.S. military affiliated residencies' graduating internal medicine residents in December 2016-January 2017. Data were analyzed by decision to apply to fellowship and decision to extend military obligation using Fisher's exact test or Pearon's chi-square test. Sixty-eight residents from 10 of 11 military residency programs responded, for a response rate of 51%. The majority (62%) applied to fellowship to start after residency completion. Reasons cited for applying to fellowship included wanting to become a specialist as soon as possible (74%), wishing to avoid being a general internist (57%), and because they are unable to practice as a hospitalist in the military (52%). Fellowship applicants were more likely to plan to extend their military obligation than non-applicants, as did those with longer duration of military commitments. No other factors, including Uniformed Services University attendance or participation in undergraduate military experiences, were found to impact plan to extend active duty service commitment. The majority of graduating internal medicine residents apply for fellowship and report a desire to avoid being a

  13. Documentation of quality improvement exposure by internal medicine residency applicants.

    Science.gov (United States)

    Kolade, Victor O; Sethi, Anuradha

    2016-01-01

    Quality improvement (QI) has become an essential component of medical care in the United States. In residency programs, QI is a focus area of the Clinical Learning Environment Review visits conducted by the Accreditation Council for Graduate Medical Education. The readiness of applicants to internal medicine residency to engage in QI on day one is unknown. To document the reporting of QI training or experience in residency applications. Electronic Residency Application Service applications to a single internal medicine program were reviewed individually looking for reported QI involvement or actual projects in the curriculum vitae (CVs), personal statements (PSs), and letters of recommendation (LORs). CVs were also reviewed for evidence of education in QI such as completion of Institute for Healthcare Improvement (IHI) modules. Of 204 candidates shortlisted for interview, seven had QI items on their CVs, including one basic IHI certificate. Three discussed their QI work in their PSs, and four had recommendation letters describing their involvement in QI. One applicant had both CV and LOR evidence, so that 13 (6%) documented QI engagement. Practice of or instruction in QI is rarely mentioned in application documents of prospective internal medicine interns.

  14. Training Pathology Residents to Practice 21st Century Medicine: A Proposal.

    Science.gov (United States)

    Black-Schaffer, W Stephen; Morrow, Jon S; Prystowsky, Michael B; Steinberg, Jacob J

    2016-01-01

    Scientific advances, open information access, and evolving health-care economics are disrupting extant models of health-care delivery. Physicians increasingly practice as team members, accountable to payers and patients, with improved efficiency, value, and quality. This change along with a greater focus on population health affects how systems of care are structured and delivered. Pathologists are not immune to these disruptors and, in fact, may be one of the most affected medical specialties. In the coming decades, it is likely that the number of practicing pathologists will decline, requiring each pathologist to serve more and often sicker patients. The demand for increasingly sophisticated yet broader diagnostic skills will continue to grow. This will require pathologists to acquire appropriate professional training and interpersonal skills. Today's pathology training programs are ill designed to prepare such practitioners. The time to practice for most pathology trainees is typically 5 to 6 years. Yet, trainees often lack sufficient experience to practice independently and effectively. Many studies have recognized these challenges suggesting that more effective training for this new century can be implemented. Building on the strengths of existing programs, we propose a redesign of pathology residency training that will meet (and encourage) a continuing evolution of American Board of Pathology and Accreditation Council for Graduate Medical Education requirements, reduce the time to readiness for practice, and produce more effective, interactive, and adaptable pathologists. The essence of this new model is clear definition and acquisition of core knowledge and practice skills that span the anatomic and clinical pathology continuum during the first 2 years, assessed by competency-based metrics with emphasis on critical thinking and skill acquisition, followed by individualized modular training with intensively progressive responsibility during the final years of

  15. Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents.

    Science.gov (United States)

    West, Colin P; Shanafelt, Tait D; Kolars, Joseph C

    2011-09-07

    Physician distress is common and has been associated with negative effects on patient care. However, factors associated with resident distress and well-being have not been well described at a national level. To measure well-being in a national sample of internal medicine residents and to evaluate relationships with demographics, educational debt, and medical knowledge. Study of internal medicine residents using data collected on 2008 and 2009 Internal Medicine In-Training Examination (IM-ITE) scores and the 2008 IM-ITE survey. Participants were 16,394 residents, representing 74.1% of all eligible US internal medicine residents in the 2008-2009 academic year. This total included 7743 US medical graduates and 8571 international medical graduates. Quality of life (QOL) and symptoms of burnout were assessed, as were year of training, sex, medical school location, educational debt, and IM-ITE score reported as percentage of correct responses. Quality of life was rated "as bad as it can be" or "somewhat bad" by 2402 of 16,187 responding residents (14.8%). Overall burnout and high levels of emotional exhaustion and depersonalization were reported by 8343 of 16,192 (51.5%), 7394 of 16,154 (45.8%), and 4541 of 15,737 (28.9%) responding residents, respectively. In multivariable models, burnout was less common among international medical graduates than among US medical graduates (45.1% vs 58.7%; odds ratio, 0.70 [99% CI, 0.63-0.77]; P $200,000 relative to no debt). Residents reporting QOL "as bad as it can be" and emotional exhaustion symptoms daily had mean IM-ITE scores 2.7 points (99% CI, 1.2-4.3; P ITE scores 5.0 points (99% CI, 4.4-5.6; P ITE scores.

  16. Precision Radiology Residency Training: Special Distinction Tracks for Noninterpretative Professional Development.

    Science.gov (United States)

    Snyder, Elizabeth; Solnes, Lilja; Horton, Karen M; Johnson, Pamela T

    2018-06-01

    The role of a radiologist has expanded beyond the tripartite mission of patient care, education, and research to include cross-specialty consultation for patient management, innovative solutions to improve health-care quality and safety, device design, and policy advocacy. As such, radiology residency programs should incorporate formalized training to prepare residents for these various professional roles. Since the 2015-2016 academic year, five training tracks focused on noninterpretative skills have been integrated into our residency training program: Clinician Educator, Quality Improvement, Entrepreneurship/Innovation, Health Policy Advocacy, and High-Value Care. Each track is longitudinal, with a set of requirements throughout the residents' training necessary to achieve certification at graduation. To date nine residents have participated in the programs, including two who received distinction in two separate tracks. Residents in each of the tracks have implemented successful initiatives related to the focus area. As such, these tracks enrich training by ensuring that residents make meaningful contributions to the department and institution during their training and disseminate successful initiatives through presentation at national meetings and publications. The duration of a radiology residency and resources available in an academic center provide opportunities for residency program directors to advance residents' skills in important noninterpretative components of radiology practice. Regardless of whether residents pursue academic medicine or private practice, these skills are necessary for graduates to become valuable members of a radiology practice and serve as national leaders in the field of radiology. Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  17. Curriculum Design and Implementation of the Emergency Medicine Chief Resident Incubator.

    Science.gov (United States)

    Gisondi, Michael A; Chou, Adaira; Joshi, Nikita; Sheehy, Margaret K; Zaver, Fareen; Chan, Teresa M; Riddell, Jeffrey; Sifford, Derek P; Lin, Michelle

    2018-02-24

    Background Chief residents receive minimal formal training in preparation for their administrative responsibilities. There is a lack of professional development programs specifically designed for chief residents. Objective In 2015, Academic Life in Emergency Medicine designed and implemented an annual, year-long, training program and virtual community of practice for chief residents in emergency medicine (EM). This study describes the curriculum design process and reports measures of learner engagement during the first two cycles of the curriculum. Methods Kern's Six-Step Approach for curriculum development informed key decisions in the design and implementation of the Chief Resident Incubator. The resultant curriculum was created using constructivist social learning theory, with specific objectives that emphasized the needs for a virtual community of practice, longitudinal content delivery, mentorship for participants, and the facilitation of multicenter digital scholarship. The 12-month curriculum included 11 key administrative or professional development domains, delivered using a combination of digital communications platforms. Primary outcomes measures included markers of learner engagement with the online curriculum, recognized as modified Kirkpatrick Level One outcomes for digital learning. Results An average of 206 chief residents annually enrolled in the first two years of the curriculum, with an overall participation by 33% (75/227) of the allopathic EM residency programs in the United States (U.S.). There was a high level of learner engagement, with an average 13,414 messages posted per year. There were also 42 small group teaching sessions held online, which included 39 faculty and 149 chief residents. The monthly e-newsletter had a 50.7% open rate. Digital scholarship totaled 23 online publications in two years, with 67 chief resident co-authors and 21 faculty co-authors. Conclusions The Chief Resident Incubator is a virtual community of practice that

  18. Resident response to integration of simulation-based education into emergency medicine conference.

    Science.gov (United States)

    Wang, Ernest E; Beaumont, Jennifer; Kharasch, Morris; Vozenilek, John A

    2008-11-01

    Utilization of simulation-based training has become increasingly prevalent in residency training. The authors compared emergency medicine (EM) resident feedback for simulation sessions to traditional lectures from an EM residency didactic program. The authors performed a retrospective review of all written EM conference evaluations over a 29-month period. Evaluation questions were scored on a 1-9 Likert scale. Lectures and simulation accounted for 77.6 and 22.4% of the conferences, respectively. Scored means (+/-standard deviations [SDs]) were as follows: overall, lecture 7.97 +/- 0.74 versus simulation 8.373 +/- 0.44 (p higher than traditional lectures. The scores over time suggest that this preference for simulation can be sustainable long term. Residents perceive simulation as more desirable teaching method compared to the traditional lecture format.

  19. Assimilating Traditional Healing Into Preventive Medicine Residency Curriculum.

    Science.gov (United States)

    Kesler, Denece O; Hopkins, L Olivia; Torres, Eliseo; Prasad, Arti

    2015-11-01

    Comprehensive cultural competency includes knowledge and awareness of culturally based healing and wellness practices. Healthcare providers should be aware of the individual patient's beliefs, culture, and use of culturally based health practices because patients may adopt such practices for general wellness or as adjunct therapies without the benefit of discussion with their healthcare provider. This article describes the culturally based traditional healing curriculum that has been implemented in the University of New Mexico Public Health and General Preventive Medicine Residency Program in order to fulfill this knowledge necessity. Curricular elements were added in a stepwise manner starting in 2011, with the full content as described implemented starting in 2013. Data were collected annually with evaluation of the full curriculum occurring in 2015. New Mexico has a diverse population base that includes predominantly Hispanic and Native American cultures, making the inclusion of curriculum regarding traditional healing practices very pertinent. Residents at the University of New Mexico were educated through several curricular components about topics such as Curanderismo, the art of Mexican Folk Healing. An innovative approach was used, with a compendium of training methods that included learning directly from traditional healers and participation in healing practices. The incorporation of this residency curriculum resulted in a means to produce physicians well trained in approaching patient care and population health with knowledge of culturally based health practices in order to facilitate healthy patients and communities. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  20. The anticoagulation choices of internal medicine residents for stroke prevention in non-valvular atrial fibrillation.

    Science.gov (United States)

    Moulson, Nathaniel; McIntyre, William F; Oqab, Zardasht; Yazdan-Ashoori, Payam; Quinn, Kieran L; van Oosten, Erik; Hopman, Wilma M; Baranchuk, Adrian

    2017-06-01

    To explore the oral anticoagulation (OAC) prescribing choices of Canadian internal medicine residents, at different training levels, in comparison with the Canadian Cardiovascular Society (CCS) guidelines for non-valvular atrial fibrillation (NVAF). Cross-sectional, web-based survey, involving clinical scenarios designed to favour the use of non-vitamin K antagonists (NOACs) as per the 2014 CCS NVAF guidelines. Additional questions were also designed to determine resident attitudes towards OAC prescribing. A total of 518 internal medicine responses were analysed, with 196 postgraduate year (PGY)-1s, 169 PGY-2s and 153 PGY-3s. The majority of residents (81%) reported feeling comfortable choosing OAC, with 95% having started OAC in the past 3 months. In the initial clinical scenario involving an uncomplicated patient with a CHADS2 score of 3, warfarin was favoured over any of the NOACs by PGY-1s (81.6% vs 73.9%), but NOACs were favoured by PGY-3s (88.3% vs 83.7%). This was the only scenario where OAC choices varied by PGY year, as each of the subsequent clinical scenarios residents generally favoured warfarin over NOACs irrespective of level of training. The majority of residents stated that they would no longer prescribe warfarin once NOAC reversal agents are available, and residents felt risk of adverse events was the most important factor when choosing OAC. Canadian internal medicine residents favoured warfarin over NOACs for patients with NVAF, which is in discordance with the evidence-based CCS guidelines. This finding persisted throughout the 3 years of core internal medicine training. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  1. Balancing the Roles of a Family Medicine Residency Faculty: A Grounded Theory Study.

    Science.gov (United States)

    Reitz, Randall; Sudano, Laura; Siler, Anne; Trimble, Kristopher

    2016-05-01

    Great variety exists in the roles that family medicine residency faculty fill in the lives of their residents. A family medicine-specific model has never been created to describe and promote effective training relationships. This research aims to create a consensus model for faculty development, ethics education, and policy creation. Using a modified grounded theory methods, researchers conducted phone interviews with 22 key informants from US family medicine residencies. Data were analyzed to delineate faculty roles, common role conflicts, and ethical principles for avoiding and managing role conflicts. Key informants were asked to apply their experience and preferences to adapt an existing model to fit with family medicine residency settings. The primary result of this research is the creation of a family medicine-specific model that describes faculty roles and provides insight into how to manage role conflicts with residents. Primary faculty roles include Role Model, Advisor, Teacher, Supervisor, and Evaluator. Secondary faculty roles include Friendly Colleague, Wellness Supporter, and Helping Hand. The secondary roles exist on a continuum from disengaged to enmeshed. When not balanced, the secondary roles can detract from the primary roles. Differences were found between role expectations of physician versus behavioral science faculty and larger/university/urban residencies versus smaller/community/rural residencies. Diversity of opinion exists related to the types of roles that are appropriate for family medicine faculty to maintain with residents. This new model is a first attempt to build consensus in the field and has application to faculty development, ethics education, and policy creation.

  2. A Survey of Graduates of Combined Emergency Medicine-Pediatrics Residency Programs: An Update.

    Science.gov (United States)

    Strobel, Ashley M; Chasm, Rose M; Woolridge, Dale P

    2016-10-01

    In 1998, emergency medicine-pediatrics (EM-PEDS) graduates were no longer eligible for the pediatric emergency medicine (PEM) sub-board certification examination. There is a paucity of guidance regarding the various training options for medical students who are interested in PEM. We sought to to determine attitudes and personal satisfaction of graduates from EM-PEDS combined training programs. We surveyed 71 graduates from three EM-PEDS residences in the United States. All respondents consider their combined training to be an asset when seeking a job, 92% find it to be an asset to their career, and 88% think it provided added flexibility to job searches. The most commonly reported shortcoming was their ineligibility for the PEM sub-board certification. The lack of this designation was perceived to be a detriment to securing academic positions in dedicated children's hospitals. When surveyed regarding which training offers the better skill set for the practice of PEM, 90% (44/49) stated combined EM-PEDS training. When asked which training track gives them the better professional advancement in PEM, 52% (23/44) chose combined EM-PEDS residency, 27% (12/44) chose a pediatrics residency followed by a PEM fellowship, and 25% (11/44) chose an EM residency then a PEM fellowship. No EM-PEDS respondents considered PEM fellowship training after the completion of the dual training program. EM-PEDS graduates found combined training to be an asset in their career. They felt that it provided flexibility in job searches, and that it was ideal training for the skill set required for the practice of PEM. EM-PEDS graduates' practices varied, including mixed settings, free-standing children's hospitals, and community emergency departments. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Rwandan family medicine residents expanding their training into South Africa: the use of South-South medical electives in enhancing learning experiences.

    Science.gov (United States)

    Flinkenflögel, Maaike; Ogunbanjo, Gboyega; Cubaka, Vincent Kalumire; De Maeseneer, Jan

    2015-08-01

    International medical electives are well-accepted in medical education, with the flow of students generally being North-South. In this article we explore the learning outcomes of Rwandan family medicine residents who completed their final year elective in South Africa. We compare the learning outcomes of this South-South elective to those of North-South electives from the literature. In-depth interviews were conducted with Rwandan postgraduate family medicine residents who completed a 4-week elective in South Africa during their final year of training. The interviews were thematically analysed in an inductive way. The residents reported important learning outcomes in four overarching domains namely: medical, organisational, educational, and personal. The learning outcomes of the residents in this South-South elective had substantial similarities to findings in literature on learning outcomes of students from the North undertaking electives in the Southern hemisphere. Electives are a useful learning tool, both for Northern students, and students from universities in the South. A reciprocity-framework is needed to increase mutual benefits for Southern universities when students from the North come for electives. We suggest further research on the possibility of supporting South-South electives by Northern colleagues.

  4. Characteristics and Outcomes of an Innovative Train-in-Place Residency Program.

    Science.gov (United States)

    Green-McKenzie, Judith; Emmett, Edward A

    2017-10-01

    Physicians who make a midcareer specialty change may find their options for formal training are limited. Here, we describe a train-in-place program, with measureable outcomes, created to train midcareer physicians who desire formal training in occupational medicine. We evaluated educational outcomes from a novel residency program for midcareer physicians seeking formal training and board certification in occupational medicine. Physicians train in place at selected clinical training sites where they practice, and participate in 18 visits to the primary training site over a 2-year period. Program components include competency-based training structured around rotations, mentored projects, and periodic auditing visits to train-in-site locations by program faculty. Main outcome measures are achievement of Accreditation Council for Graduate Medical Education Occupational Medicine Milestones, American College of Occupational and Environmental Medicine competencies, performance on the American College of Preventive Medicine examinations, diversity in selection, placement of graduates, and the number of graduates who remain in the field. Since inception of this program in 1997, there have been 109 graduates who comprise 7.2% of new American Board of Preventive Medicine diplomates over the past decade. Graduates scored competitively on the certifying examination, achieved all milestones, expressed satisfaction with training, and are geographically dispersed, representing every US region. Most practice outside the 25 largest standard metropolitan statistical areas. More than 95% have remained in the field. Training in place is an effective approach to provide midcareer physicians seeking comprehensive skills and board certification in occupational medicine formal training, and may be adaptable to other specialties.

  5. Learning behaviour and preferences of family medicine residents under a flexible academic curriculum.

    Science.gov (United States)

    Sy, Alice; Wong, Eric; Boisvert, Leslie

    2014-11-01

    To determine family medicine residents' learning behaviour and preferences outside of clinical settings in order to help guide the development of an effective academic program that can maximize their learning. Retrospective descriptive analysis of academic learning logs submitted by residents as part of their academic training requirements between 2008 and 2011. London, Ont. All family medicine residents at Western University who had completed their academic program requirements (N = 72) by submitting 300 or more credits (1 credit = 1 hour). Amount of time spent on various learning modalities, location where the learning took place, resources used for self-study, and the objective of the learning activity. A total of 72 residents completed their academic requirements during the study period and logged a total of 25 068 hours of academic learning. Residents chose to spend most of their academic time engaging in self-study (44%), attending staff physicians' teaching sessions (20%),and participating in conferences, courses, or workshops (12%) and in postgraduate medical education sessions (12%). Textbooks (26%), medical journals (20%), and point-of-care resources (12%) were the 3 most common resources used for self-study. The hospital (32%), residents' homes (32%),and family medicine clinics (14%) were the most frequently cited locations where academic learning occurred. While all physicians used a variety of educational activities, most residents (67%) chose self-study as their primary method of learning. The topic for academic learning appeared to have some influence on the learning modalities used by residents. Residents used a variety of learning modalities and chose self-study over other more traditional modalities (eg, lectures) for most of their academic learning. A successful academic program must take into account residents' various learning preferences and habits while providing guidance and training in the use of more effective learning methods and

  6. Primary care resident perceived preparedness to deliver cross-cultural care: an examination of training and specialty differences.

    Science.gov (United States)

    Greer, Joseph A; Park, Elyse R; Green, Alexander R; Betancourt, Joseph R; Weissman, Joel S

    2007-08-01

    Previous research has shown that resident physicians report differences in training across primary care specialties, although limited data exist on education in delivering cross-cultural care. The goals of this study were to identify factors that relate to primary care residents' perceived preparedness to provide cross-cultural care and to explore the extent to which these perceptions vary across primary care specialties. Cross-sectional, national mail survey of resident physicians in their last year of training. Eleven hundred fifty primary care residents specializing in family medicine (27%), internal medicine (23%), pediatrics (26%), and obstetrics/gynecology (OB/GYN) (24%). Male residents as well as those who reported having graduated from U.S. medical schools, access to role models, and a greater cross-cultural case mix during residency felt more prepared to deliver cross-cultural care. Adjusting for these demographic and clinical factors, family practice residents were significantly more likely to feel prepared to deliver cross-cultural care compared to internal medicine, pediatric, and OB/GYN residents. Yet, when the quantity of instruction residents reported receiving to deliver cross-cultural care was added as a predictor, specialty differences became nonsignificant, suggesting that training opportunities better account for the variability in perceived preparedness than specialty. Across primary care specialties, residents reported different perceptions of preparedness to deliver cross-cultural care. However, this variation was more strongly related to training factors, such as the amount of instruction physicians received to deliver such care, rather than specialty affiliation. These findings underscore the importance of formal education to enhance residents' preparedness to provide cross-cultural care.

  7. Integrating addiction medicine training into medical school and residency curricula

    OpenAIRE

    Klimas, Jan; Rieb, Launette; Bury, Gerard; Muench, John; O?Toole, Thomas; Rieckman, Traci; Cullen, Walter

    2015-01-01

    peer-reviewed Background: The Affordable Care Act (2010) brings an opportunity to increase the integration of addiction treatment into the health care system. With the anticipated expansion of addiction care services in primary care, challenges, such as workforce training, can be expected. This presentation discusses challenges and opportunities for addiction medicine training of primary care professionals in Ireland, Canada and Portland, OR. Objectives: To explore ideas for integratin...

  8. Five Key Leadership Actions Needed to Redesign Family Medicine Residencies.

    Science.gov (United States)

    Kozakowski, Stanley M; Eiff, M Patrice; Green, Larry A; Pugno, Perry A; Waller, Elaine; Jones, Samuel M; Fetter, Gerald; Carney, Patricia A

    2015-06-01

    New skills are needed to properly prepare the next generation of physicians and health professionals to practice in medical homes. Transforming residency training to address these new skills requires strong leadership. We sought to increase the understanding of leadership skills useful in residency programs that plan to undertake meaningful change. The Preparing the Personal Physician for Practice (P4) project (2007-2014) was a comparative case study of 14 family medicine residencies that engaged in innovative training redesign, including altering the scope, content, sequence, length, and location of training to align resident education with requirements of the patient-centered medical home. In 2012, each P4 residency team submitted a final summary report of innovations implemented, overall insights, and dissemination activities during the study. Six investigators conducted independent narrative analyses of these reports. A consensus meeting held in September 2012 was used to identify key leadership actions associated with successful educational redesign. Five leadership actions were associated with successful implementation of innovations and residency transformation: (1) manage change; (2) develop financial acumen; (3) adapt best evidence educational strategies to the local environment; (4) create and sustain a vision that engages stakeholders; and (5) demonstrate courage and resilience. Residency programs are expected to change to better prepare their graduates for a changing delivery system. Insights about effective leadership skills can provide guidance for faculty to develop the skills needed to face practical realities while guiding transformation.

  9. Emergency medicine resident education in palliative care: a needs assessment.

    Science.gov (United States)

    Lamba, Sangeeta; Pound, Amy; Rella, Joseph G; Compton, Scott

    2012-05-01

    Hospice and Palliative Medicine is a newly designated subspecialty of Emergency Medicine (EM). As yet, no well defined palliative care (PC) models for education or training exist. A needs assessment is the first step towards developing a curriculum. To characterize emergency physicians' (EP) perceived educational and formal training needs for PC related skills. All EM residents and faculty of one academic facility were asked to complete an anonymous needs-assessment survey. Participants were asked to rank statements related to attitudes about PC and rate their formal training and knowledge in 10 aspects of PC using a 5-point Likert-scale. EPs also ranked 4 learning modalities in order of preference and 12 PC educational topics in order of perceived importance in an EM curriculum. Ninety-three percent (42/45) of eligible participants completed the survey (28 residents, 14 faculty). Respondents agreed/strongly agreed that PC skills are an important competence for EM (88%, 37/42) and that they would "like to have more training/education in PC" (79%, 33/42). Respondents also disagreed/strongly disagreed with the statement that "PC consult is called when no more can be done for the patient" (90%, 38/42). Important PC topics identified were pain management, discussing code status, and management of dyspnea and other symptoms in terminal illness. Bedside teaching was listed as the preferred learning modality. EM residents reported minimal training in pain management (46%, 13/28), managing hospice patients (54%, 15/28), withdrawal/withholding life support (54%, 15/28), and managing the imminently dying (43%, 12/28). There was no consistent, significant improvement reported in any domain as training and experience progressed from PGY (postgraduate year) 1 to PGY 4 to attending physician. EPs view PC skills as important for EM practice and report that they are not yet adequately educated and trained in providing PC. Domains of particular interest and targeted areas for PC

  10. Emergency department operations and management education in emergency medicine training

    Institute of Scientific and Technical Information of China (English)

    Bret A Nicks; Darrell Nelson

    2012-01-01

    BACKGROUND:This study was undertaken to examine the current level of operations and management education within US-based Emergency Medicine Residency programs.METHODS:Residency program directors at all US-based Emergency Medicine Residency programs were anonymously surveyed via a web-based instrument.Participants indicated their levels of residency education dedicated to documentation,billing/coding,core measure/quality indicator compliance,and operations management.Data were analyzed using descriptive statistics for the ordinal data/Likert scales.RESULTS:One hundred and six(106)program directors completed the study instrument of one hundred and fifty-six(156)programs(70%).Of these,82.6%indicated emergency department(ED)operations and management education within the training curriculum.Dedicated documentation training was noted in all but 1 program(99%).Program educational offerings also included billing/coding(83%),core measure/quality indicators(78%)and operations management training(71%).In all areas,the most common means of educating came through didactic sessions and direct attending feedback or 69%-94%and 72%-98%respectively.Residency leadership was most confident with resident understanding of quality documentation(80%)and less so with core measures(72%),billing/coding/RVUs(58%),and operations management tools(23%).CONCLUSIONS:While most EM residency programs integrate basic operational education related to documentation and billing/coding,a smaller number provide focused education on the dayto-day management and operations of the ED.Residency leadership perceives graduating resident understanding of operational management tools to be limited.All respondents value further resident curriculum development of ED operations and management.

  11. Correlation of United States Medical Licensing Examination and Internal Medicine In-Training Examination Performance

    Science.gov (United States)

    Perez, Jose A., Jr.; Greer, Sharon

    2009-01-01

    The Internal Medicine In-Training Examination (ITE) is administered during residency training in the United States as a self-assessment and program assessment tool. Performance on this exam correlates with outcome on the American Board of Internal Medicine Certifying examination. Internal Medicine Program Directors use the United States Medical…

  12. Mexico, maquiladoras, and occupational medicine training.

    Science.gov (United States)

    Cordes, D H; Rea, D F; Schwartz, I; Rea, J

    1989-01-01

    Industrialization and its concomitant social and environmental effects in developing countries are considered in this paper. Mexico offers one example of economic progress achieved through the promotion of industrial growth. Recognising the need for trained experts with global experience in occupational health, the University of Arizona (UA) has begun a programme to train occupational and preventive medicine residents in international aspects of occupational health in the nearby industrialized border regions of Mexico. By using the maquiladora (assembly plant) industries and the resources of the Instituto Mexicano del Seguro Social with the State of Sonora, residents observe existing problems in occupational safety and health in addition to adding to their understanding of the need for worldwide cooperation for research and reform in this field.

  13. Can Emergency Medicine Residents Predict Cost of Diagnostic Testing?

    Directory of Open Access Journals (Sweden)

    Tainter, Christopher R

    2017-01-01

    Full Text Available Diagnostic testing represents a significant portion of healthcare spending, and cost should be considered when ordering such tests. Needless and excessive spending may occur without an appreciation of the impact on the larger healthcare system. Knowledge regarding the cost of diagnostic testing among emergency medicine (EM residents has not previously been studied. A survey was administered to 20 EM residents from a single ACGME-accredited three-year EM residency program, asking for an estimation of patient charges for 20 commonly ordered laboratory tests and seven radiological exams. We compared responses between residency classes to evaluate whether there was a difference based on level of training. The survey completion rate was 100% (20/20 residents. We noted significant discrepancies between the median resident estimates and actual charge to patient for both laboratory and radiological exams. Nearly all responses were an underestimate of the actual cost. The group median underestimation for laboratory testing was $114, for radiographs $57, and for computed tomography exams was $1,058. There was improvement in accuracy with increasing level of training. This pilot study demonstrates that EM residents have a poor understanding of the charges burdening patients and health insurance providers. In order to make balanced decisions with regard to diagnostic testing, providers must appreciate these factors. Education regarding the cost of providing emergency care is a potential area for improvement of EM residency curricula, and warrants further attention and investigation.

  14. Nuclear medicine training and practice in the Czech Republic

    International Nuclear Information System (INIS)

    Kaminek, Milan; Koranda, Pavel

    2014-01-01

    Nuclear medicine in the Czech Republic is a full specialty with an exclusive practice. Since the training program was organized and structured in recent years, residents have had access to the specialty of nuclear medicine, starting with a two-year general internship (in internal medicine or radiology). At present, nuclear medicine services are provided in 45 departments. In total, 119 nuclear medicine specialists are currently registered. In order to obtain the title of Nuclear Medicine Specialist, five years of training are necessary; the first two years consist of a general internship in internal medicine or radiology. The remaining three years consist of training in the nuclear medicine specialty itself, but includes three months of practice in radiology. Twenty-one physicians are currently in nuclear medicine training and a mean of three specialists pass the final exam per year. The syllabus is very similar to that of the European Union of Medical Specialists (UEMS), namely concerning the minimum recommended numbers for diagnostic and therapeutic procedures. In principle, the Czech law requires continuous medical education for all practicing doctors. The Czech Medical Chamber has provided a continuing medical education (CME) system. Other national CMEs are not accepted in Czech Republic. (orig.)

  15. Nuclear medicine training and practice in the Czech Republic

    Energy Technology Data Exchange (ETDEWEB)

    Kaminek, Milan; Koranda, Pavel [University Hospital Olomouc, Department of Nuclear Medicine, Olomouc (Czech Republic)

    2014-08-15

    Nuclear medicine in the Czech Republic is a full specialty with an exclusive practice. Since the training program was organized and structured in recent years, residents have had access to the specialty of nuclear medicine, starting with a two-year general internship (in internal medicine or radiology). At present, nuclear medicine services are provided in 45 departments. In total, 119 nuclear medicine specialists are currently registered. In order to obtain the title of Nuclear Medicine Specialist, five years of training are necessary; the first two years consist of a general internship in internal medicine or radiology. The remaining three years consist of training in the nuclear medicine specialty itself, but includes three months of practice in radiology. Twenty-one physicians are currently in nuclear medicine training and a mean of three specialists pass the final exam per year. The syllabus is very similar to that of the European Union of Medical Specialists (UEMS), namely concerning the minimum recommended numbers for diagnostic and therapeutic procedures. In principle, the Czech law requires continuous medical education for all practicing doctors. The Czech Medical Chamber has provided a continuing medical education (CME) system. Other national CMEs are not accepted in Czech Republic. (orig.)

  16. Real time curriculum map for internal medicine residency

    Directory of Open Access Journals (Sweden)

    Roberts J Mark

    2007-11-01

    Full Text Available Abstract Background To manage the voluminous formal curriculum content in a limited amount of structured teaching time, we describe the development and evaluation of a curriculum map for academic half days (AHD in a core internal medicine residency program. Methods We created a 3-year cyclical curriculum map (an educational tool combining the content, methodology and timetabling of structured teaching, comprising a matrix of topics under various specialties/themes and corresponding AHD hours. All topics were cross-matched against the ACP-ASIM in-training examination, and all hours were colour coded based on the categories of core competencies. Residents regularly updated the map on a real time basis. Results There were 208 topics covered in 283 AHD hours. All topics represented core competencies with minimal duplication (78% covered once in 3 years. Only 42 hours (15% involved non-didactic teaching, which increased after implementation of the map (18–19 hours/year versus baseline 5 hours/year. Most AHD hours (78% focused on medical expert competencies. Resident satisfaction (90% response was high throughout (range 3.64 ± 0.21, 3.84 ± 0.14 out of 4, which improved after 1 year but returned to baseline after 2 years. Conclusion We developed and implemented an internal medicine curriculum map based on real time resident input, with minimal topic duplication and high resident satisfaction. The map provided an opportunity to balance didactic versus non-didactic teaching, and teaching on medical versus non medical expert topics.

  17. Are All Competencies Equal in the Eyes of Residents? A Multicenter Study of Emergency Medicine Residents' Interest in Feedback.

    Science.gov (United States)

    Bentley, Suzanne; Hu, Kevin; Messman, Anne; Moadel, Tiffany; Khandelwal, Sorabh; Streich, Heather; Noelker, Joan

    2017-01-01

    Feedback, particularly real-time feedback, is critical to resident education. The emergency medicine (EM) milestones were developed in 2012 to enhance resident assessment, and many programs use them to provide focused resident feedback. The purpose of this study was to evaluate EM residents' level of interest in receiving real-time feedback on each of the 23 competencies/sub-competencies. This was a multicenter cross-sectional study of EM residents. We surveyed participants on their level of interest in receiving real-time on-shift feedback on each of the 23 competencies/sub-competencies. Anonymous paper or computerized surveys were distributed to residents at three four-year training programs and three three-year training programs with a total of 223 resident respondents. Residents rated their level of interest in each milestone on a six-point Likert-type response scale. We calculated average level of interest for each of the 23 sub-competencies, for all 223 respondents and separately by postgraduate year (PGY) levels of training. One-way analyses of variance were performed to determine if there were differences in ratings by level of training. The overall survey response rate across all institutions was 82%. Emergency stabilization had the highest mean rating (5.47/6), while technology had the lowest rating (3.24/6). However, we observed no differences between levels of training on any of the 23 competencies/sub-competencies. Residents seem to ascribe much more value in receiving feedback on domains involving high-risk, challenging procedural skills as compared to low-risk technical and communication skills. Further studies are necessary to determine whether residents' perceived importance of competencies/sub-competencies needs to be considered when developing an assessment or feedback program based on these 23 EM competencies/sub-competencies.

  18. The resident's view of residency training in Canada.

    Science.gov (United States)

    Fish, D G

    1966-04-09

    In the view of residents in their last year of specialty training, the Fellowship is now becoming the operative standard for obtaining hospital privileges in urban centres and they felt that this implied that the two standards, the Certificate and the Fellowship of the Royal College, were not achieving the purpose for which they were designed. Although 80% of the residents intended to write the Fellowship, few viewed a year in a basic science department or in research as of intrinsic value in terms of their future practice.The examinations of the Royal College were the subject of criticism, most residents feeling that the examinations did not test the knowledge and ability gained in training. Most expressed a desire for ongoing evaluation during the training period.Service responsibilities were generally regarded as too heavy.Despite the criticism of both training and examination, most residents felt that their training had provided them with the experience and background they needed to practise as specialists.

  19. Addressing the leadership gap in medicine: residents' need for systematic leadership development training.

    Science.gov (United States)

    Blumenthal, Daniel M; Bernard, Ken; Bohnen, Jordan; Bohmer, Richard

    2012-04-01

    All clinicians take on leadership responsibilities when delivering care. Evidence suggests that effective clinical leadership yields superior clinical outcomes. However, few residency programs systematically teach all residents how to lead, and many clinicians are inadequately prepared to meet their day-to-day clinical leadership responsibilities. The purpose of this article is twofold: first, to make the case for the need to refocus residency education around the development of outstanding "frontline" clinical leaders and, second, to provide an evidence-based framework for designing formal leadership development programs for residents. The authors first present a definition of clinical leadership and highlight evidence that effective frontline clinical leadership improves both clinical outcomes and satisfaction for patients and providers. The authors then discuss the health care "leadership gap" and describe barriers to implementing leadership development training in health care. Next, they present evidence that leaders are not just "born" but, rather, can be "made," and offer a set of best practices to facilitate the design of leadership development programs. Finally, the authors suggest approaches to mitigating barriers to implementing leadership development programs and highlight the major reasons why health care delivery organizations, residency programs, and national accreditation bodies must make comprehensive leadership education an explicit goal of residency training.

  20. Preparing Emergency Medicine Residents to Disclose Medical Error Using Standardized Patients

    Directory of Open Access Journals (Sweden)

    Carmen N. Spalding

    2017-12-01

    Full Text Available Introduction Emergency Medicine (EM is a unique clinical learning environment. The American College of Graduate Medical Education Clinical Learning Environment Review Pathways to Excellence calls for “hands-on training” of disclosure of medical error (DME during residency. Training and practicing key elements of DME using standardized patients (SP may enhance preparedness among EM residents in performing this crucial skill in a clinical setting. Methods This training was developed to improve resident preparedness in DME in the clinical setting. Objectives included the following: the residents will be able to define a medical error; discuss ethical and professional standards of DME; recognize common barriers to DME; describe key elements in effective DME to patients and families; and apply key elements during a SP encounter. The four-hour course included didactic and experiential learning methods, and was created collaboratively by core EM faculty and subject matter experts in conflict resolution and healthcare simulation. Educational media included lecture, video exemplars of DME communication with discussion, small group case-study discussion, and SP encounters. We administered a survey assessing for preparedness in DME pre-and post-training. A critical action checklist was administered to assess individual performance of key elements of DME during the evaluated SP case. A total of 15 postgraduate-year 1 and 2 EM residents completed the training. Results After the course, residents reported increased comfort with and preparedness in performing several key elements in DME. They were able to demonstrate these elements in a simulated setting using SP. Residents valued the training, rating the didactic, SP sessions, and overall educational experience very high. Conclusion Experiential learning using SP is effective in improving resident knowledge of and preparedness in performing medical error disclosure. This educational module can be adapted

  1. Psychotherapy Training: Residents' Perceptions and Experiences.

    Science.gov (United States)

    Kovach, Jessica G; Dubin, William R; Combs, Christopher J

    2015-10-01

    This survey examined actual training hours in psychotherapy modalities as reported by residents, residents' perceptions of training needs, and residents' perceptions of the importance of different aspects of psychotherapy training. A brief, voluntary, anonymous, Internet-based survey was developed. All 14 program directors for Accreditation Council for Graduate Medical Education accredited programs in Pennsylvania, New Jersey, and Delaware provided email addresses for current categorical residents. The survey inquired about hours of time spent in various aspects of training, value assigned to aspects of training, residents' involvement in their own psychotherapy, and overall resident wellness. The survey was e-mailed to 328 residents. Of the 328 residents contacted, 133 (40.5%) responded. Median reported number of PGY 3 and 4 performed versus perceived ideal hours of supportive therapy, cognitive behavioral therapy (CBT), and psychodynamic therapy did not differ. Answers for clinical time utilizing these modalities ranged from "none or less than 1 h" per month to 20+ h per month. PGY 3 and 4 residents reported a median of "none or less than 1 h" per month performed of interpersonal, dialectical behavior therapy, couples/family/group, and child therapies but preferred more time using these therapies. Residents in all years of training preferred more hours of didactic instruction for all psychotherapies and for medication management. Residents ranked teaching modalities in the following order of importance: supervision, hours of psychotherapy performed, personal psychotherapy, readings, and didactic instruction. Residents engaged in their own psychotherapy were significantly more likely to rank the experiential aspects of psychotherapy training (personal psychotherapy, supervision, and hours performed) higher than residents not in psychotherapy. Current psychotherapy training for psychiatry residents is highly variable, but overall, residents want more

  2. Emergency Medicine Resident Perceptions of Medical Professionalism.

    Science.gov (United States)

    Jauregui, Joshua; Gatewood, Medley O; Ilgen, Jonathan S; Schaninger, Caitlin; Strote, Jared

    2016-05-01

    Medical professionalism is a core competency for emergency medicine (EM) trainees; but defining professionalism remains challenging, leading to difficulties creating objectives and performing assessment. Because professionalism is dynamic, culture-specific, and often taught by modeling, an exploration of trainees' perceptions can highlight their educational baseline and elucidate the importance they place on general conventional professionalism domains. To this end, our objective was to assess the relative value EM residents place on traditional components of professionalism. We performed a cross-sectional, multi-institutional survey of incoming and graduating EM residents at four programs. The survey was developed using the American Board of Internal Medicine's "Project Professionalism" and the Accreditation Council of Graduate Medical Education definition of professionalism competency. We identified 27 attributes within seven domains: clinical excellence, humanism, accountability, altruism, duty and service, honor and integrity, and respect for others. Residents were asked to rate each attribute on a 10-point scale. We analyzed data to assess variance across attributes as well as differences between residents at different training levels or different institutions. Of the 114 residents eligible, 100 (88%) completed the survey. The relative value assigned to different professional attributes varied considerably, with those in the altruism domain valued significantly lower and those in the "respect for others" and "honor and integrity" valued significantly higher (p<0.001). Significant differences were found between interns and seniors for five attributes primarily in the "duty and service" domain (p<0.05). Among different residencies, significant differences were found with attributes within the "altruism" and "duty and service" domains (p<0.05). Residents perceive differences in the relative importance of traditionally defined professional attributes and this may

  3. Executive Summary from the 2017 Emergency Medicine Resident Wellness Consensus Summit

    Directory of Open Access Journals (Sweden)

    Felix Ankel

    2018-02-01

    Full Text Available Introduction: Physician wellness has recently become a popular topic of conversation and publication within the house of medicine and specifically within emergency medicine (EM. Through a joint collaboration involving Academic Life in Emergency Medicine’s (ALiEM Wellness Think Tank, Essentials of Emergency Medicine (EEM, and the Emergency Medicine Residents’ Association (EMRA, a one-day Resident Wellness Consensus Summit (RWCS was organized. Methods: The RWCS was held on May 15, 2017, as a pre-day event prior to the 2017 EEM conference in Las Vegas, Nevada. Seven months before the RWCS event, pre-work began in the ALiEM Wellness Think Tank, which was launched in October 2016. The Wellness Think Tank is a virtual community of practice involving EM residents from the U.S. and Canada, hosted on the Slack digital-messaging platform. A working group was formed for each of the four predetermined themes: wellness curriculum development; educator toolkit resources for specific wellness topics; programmatic innovations; and wellness-targeted technologies. Results: Pre-work for RWCS included 142 residents from 100 different training programs in the Wellness Think Tank. Participants in the actual RWCS event included 44 EM residents, five EM attendings who participated as facilitators, and three EM attendings who acted as participants. The four working groups ultimately reached a consensus on their specific objectives to improve resident wellness on both the individual and program level. Conclusion: The Resident Wellness Consensus Summit was a unique and novel consensus meeting, involving residents as the primary stakeholders. The summit demonstrated that it is possible to galvanize a large group of stakeholders in a relatively short time by creating robust trust, communication, and online learning networks to create resources that support resident wellness.

  4. Leadership Training in Otolaryngology Residency.

    Science.gov (United States)

    Bent, John P; Fried, Marvin P; Smith, Richard V; Hsueh, Wayne; Choi, Karen

    2017-06-01

    Although residency training offers numerous leadership opportunities, most residents are not exposed to scripted leadership instruction. To explore one program's attitudes about leadership training, a group of otolaryngology faculty (n = 14) and residents (n = 17) was polled about their attitudes. In terms of self-perception, more faculty (10 of 14, 71.4%) than residents (9 of 17, 52.9%; P = .461) considered themselves good leaders. The majority of faculty and residents (27 of 31) thought that adults could be taught leadership ability. Given attitudes about leadership ability and the potential for improvement through instruction, consideration should be given to including such training in otolaryngology residency.

  5. Aesthetic Training for Plastic Surgeons: Are Residents Getting Enough?

    Science.gov (United States)

    Papas, Athanasios; Montemurro, Paolo; Hedén, Per

    2018-02-01

    Plastic Surgery is one of the most competitive specialties in the field of medicine. However, this specialty has a unique particularity: the difficulties in Aesthetic Surgery training within the residency program. Despite the fact that the full title of the specialty is Plastic, Reconstructive, and Aesthetic Surgery and that Aesthetic Surgery is a part of the examination syllabus, the actual training in the specific area is limited. One of the solutions to this problem is Fellowships. The first author describes his personal experience with Aesthetic training and how it enhanced his knowledge in the area as well as the status of Fellowships in various training programs. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

  6. Teacher training for medical faculty and residents.

    OpenAIRE

    Craig, J L

    1988-01-01

    Since 1984 the University of British Columbia's School of Medicine has offered teaching improvement project systems (TIPS) workshops on effective teaching techniques; two workshops a year are given for medical faculty members and two a year for residents. The faculty members who conduct the workshops have received training on how to present them. The most powerful learning experience offered by TIPS is the opportunity for participants to present 10-minute teaching segments that are videotaped...

  7. Association of Group Prenatal Care in US Family Medicine Residencies With Maternity Care Practice: A CERA Secondary Data Analysis.

    Science.gov (United States)

    Barr, Wendy B; Tong, Sebastian T; LeFevre, Nicholas M

    2017-03-01

    Group prenatal care has been shown to improve both maternal and neonatal outcomes. With increasing adaption of group prenatal care by family medicine residencies, this model may serve as a potential method to increase exposure to and interest in maternity care among trainees. This study aims to describe the penetration, regional and program variations, and potential impacts on future maternity care practice of group prenatal care in US family medicine residencies. The CAFM Educational Research Alliance (CERA) conducted a survey of all US family medicine residency program directors in 2013 containing questions about maternity care training. A secondary data analysis was completed to examine relevant data on group prenatal care in US family medicine residencies and maternity care practice patterns. 23.1% of family medicine residency programs report provision of group prenatal care. Programs with group prenatal care reported increased number of vaginal deliveries per resident. Controlling for average number of vaginal deliveries per resident, programs with group prenatal care had a 2.35 higher odds of having more than 10% of graduates practice obstetrics and a 2.93 higher odds of having at least one graduate in the past 5 years enter an obstetrics fellowship. Residency programs with group prenatal care models report more graduates entering OB fellowships and practicing maternity care. Implementing group prenatal care in residency training can be one method in a multifaceted approach to increasing maternity care practice among US family physicians.

  8. The Importance of and the Complexities Associated With Measuring Continuity of Care During Resident Training: Possible Solutions Do Exist.

    Science.gov (United States)

    Carney, Patricia A; Conry, Colleen M; Mitchell, Karen B; Ericson, Annie; Dickinson, W Perry; Martin, James C; Carek, Peter J; Douglass, Alan B; Eiff, M Patrice

    2016-04-01

    Evolutions in care delivery toward the patient-centered medical home have influenced important aspects of care continuity. Primary responsibility for a panel of continuity patients is a foundational requirement in family medicine residencies. In this paper we characterize challenges in measuring continuity of care in residency training in this new era of primary care. We synthesized the literature and analyzed information from key informant interviews and group discussions with residency faculty and staff to identify the challenges and possible solutions for measuring continuity of care during family medicine training. We specifically focused on measuring interpersonal continuity at the patient level, resident level, and health care team level. Challenges identified in accurately measuring interpersonal continuity of care during residency training include: (1) variability in empanelment approaches for all patients, (2) scheduling complexity in different types of visits, (3) variability in ability to attain continuity counts at the level of the resident, and (4) shifting make-up of health care teams, especially in residency training. Possible solutions for each challenge are presented. Philosophical issues related to continuity are discussed, including whether true continuity can be achieved during residency training and whether qualitative rather than quantitative measures of continuity are better suited to residencies. Measuring continuity of care in residency training is challenging but possible, though improvements in precision and assessment of the comprehensive nature of the relationships are needed. Definitions of continuity during training and the role continuity measurement plays in residency need further study.

  9. Residents' experiences of abuse, discrimination and sexual harassment during residency training. McMaster University Residency Training Programs.

    Science.gov (United States)

    Cook, D J; Liutkus, J F; Risdon, C L; Griffith, L E; Guyatt, G H; Walter, S D

    1996-06-01

    To assess the prevalence of psychological abuse, physical assault, and discrimination on the basis of gender and sexual orientation, and to examine the prevalence and impact of sexual harassment in residency training programs. Self-administered questionnaire. McMaster University, Hamilton, Ont. Residents in seven residency training programs during the academic year from July 1993 to June 1994. Of 225 residents 186 (82.7%) returned a completed questionnaire, and 50% of the respondents were women. Prevalence of psychological abuse, physical assault and discrimination on the basis of gender and sexual orientation experienced by residents during medical training, prevalence and residents' perceived frequency of sexual harassment. Psychological abuse was reported by 50% of the residents. Some of the respondents reported physical assault, mostly by patients and their family members (14.7% reported assaults by male patients and family members, 9.8% reported assaults by female patients and family members), 5.4% of the female respondents reported assault by male supervising physicians. Discrimination on the basis of gender was reported to be common and was experienced significantly more often by female residents than by male residents (p sexual orientation. Most of the respondents experienced sexual harassment, especially in the form of sexist jokes, flirtation and unwanted compliments on their dress or figure. On average, 40% of the respondents, especially women (p sexual harassment to someone (p sexual harassment were embarassment (reported by 24.0%), anger (by 23.4%) and frustration (20.8%). Psychological abuse, discrimination on the basis of gender and sexual harassment are commonly experienced by residents in training programs. A direct, progressive, multidisciplinary approach is needed to label and address these problems.

  10. Obstetric and Gynecologic Ultrasound Curriculum and Competency Assessment in Residency Training Programs

    DEFF Research Database (Denmark)

    Abuhamad, Alfred; Minton, Katherine K; Benson, Carol B

    2018-01-01

    in Medicine assembled a multisociety task force to develop a consensus-based, standardized curriculum and competency assessment tools for obstetric and gynecologic ultrasound training in residency programs. The curriculum and competency assessment tools were developed based on existing national...... and international guidelines for the performance of obstetric and gynecologic ultrasound examinations and thus are intended to represent the minimum requirement for such training. By expert consensus, the curriculum was developed for each year of training, criteria for each competency assessment image were...... that the criteria set forth in this document will evolve with time. The task force also encourages use of ultrasound simulation in residency training and expects that simulation will play a significant part in the curriculum and the competency assessment process. Incorporating this training curriculum...

  11. Obstetric and gynecologic ultrasound curriculum and competency assessment in residency training programs

    DEFF Research Database (Denmark)

    Abuhamad, Alfred; Minton, Katherine K; Benson, Carol B

    2018-01-01

    in Medicine assembled a multisociety task force to develop a consensus-based, standardized curriculum and competency assessment tools for obstetric and gynecologic ultrasound training in residency programs. The curriculum and competency assessment tools were developed based on existing national...... and international guidelines for the performance of obstetric and gynecologic ultrasound examinations and thus are intended to represent the minimum requirement for such training. By expert consensus, the curriculum was developed for each year of training, criteria for each competency assessment image were...... that the criteria set forth in this document will evolve with time. The task force also encourages use of ultrasound simulation in residency training and expects that simulation will play a significant part in the curriculum and the competency assessment process. Incorporating this training curriculum...

  12. The Quality of Written Feedback by Attendings of Internal Medicine Residents.

    Science.gov (United States)

    Jackson, Jeffrey L; Kay, Cynthia; Jackson, Wilkins C; Frank, Michael

    2015-07-01

    Attending evaluations are commonly used to evaluate residents. Evaluate the quality of written feedback of internal medicine residents. Retrospective. Internal medicine residents and faculty at the Medical College of Wisconsin from 2004 to 2012. From monthly evaluations of residents by attendings, a randomly selected sample of 500 written comments by attendings were qualitatively coded and rated as high-, moderate-, or low-quality feedback by two independent coders with good inter-rater reliability (kappa: 0.94). Small group exercises with residents and attendings also coded the utterances as high, moderate, or low quality and developed criteria for this categorization. In-service examination scores were correlated with written feedback. There were 228 internal medicine residents who had 6,603 evaluations by 334 attendings. Among 500 randomly selected written comments, there were 2,056 unique utterances: 29% were coded as nonspecific statements, 20% were comments about resident personality, 16% about patient care, 14% interpersonal communication, 7% medical knowledge, 6% professionalism, and 4% each on practice-based learning and systems-based practice. Based on criteria developed by group exercises, the majority of written comments were rated as moderate quality (65%); 22% were rated as high quality and 13% as low quality. Attendings who provided high-quality feedback rated residents significantly lower in all six of the Accreditation Council for Graduate Medical Education (ACGME) competencies (p service examination scores. Most attending written evaluation was of moderate or low quality. Attendings who provided high-quality feedback appeared to be more discriminating, providing significantly lower ratings of residents in all six ACGME core competencies, and across a greater range. Attendings' negative written comments on medical knowledge correlated with lower in-service training scores.

  13. Knowledge, attitude, and practices toward ayurvedic medicine use among allopathic resident doctors: A cross-sectional study at a tertiary care hospital in India.

    Science.gov (United States)

    Gawde, Suchita R; Shetty, Yashashri C; Pawar, Dattatray B

    2013-07-01

    Ayurveda is most commonly practiced form of complementary and alternative medicine (CAM) in India. There are very few studies showing the knowledge, attitude, and practices (KAP) of allopathic doctors about Ayurvedic drugs and its use. The study was initiated to assess KAP toward Ayurvedic medicine use among allopathic resident doctors. Cross-sectional and prospective study. After obtaining permission from the Institutional Ethics Committee, allopathic resident doctors from clinical departments were approached personally. They were given pre-formed validated questionnaire to assess KAP toward Ayurvedic medicine use. Descriptive statistics. Allopathic residents had little knowledge about basic concepts of Ayurveda, that is, 'panchakarma' and 'tridosha'. Majority residents (99%) had no opportunity to learn basics of Ayurveda, but 67% residents prescribed Ayurvedic medicines to patients. However, many residents (76%) mentioned that cross practice should not be allowed due to lack of knowledge. One resident knew that cross-practice was not allowed by law. The commonly prescribed proprietary Ayurvedic medicines were Liv-52 (39%), Shatavari (13%), Cystone (12%) and common ailments for which these medicines prescribed were liver disorders (34%), arthritis (18%), cough and cold (13%), kidney stones (11%), and piles (10%). Nearly 76% residents felt incorporation of Ayurveda with modern medicine would attract more patients and at the same time most residents (92%) agreed that Ayurvedic medicines need scientific testing before use. Though 50% of the residents agreed for voluntary training in Ayurveda, 80% denied compulsory training. Nearly 63% residents recommended Ayurveda among all CAMs. Most of residents heard of Ayurveda from their colleagues. This study reveals that allopathic resident doctors had little knowledge about Ayurveda and Ayurvedic medicine use but engaged in prescription of Ayurvedic medicines. So some interventions should be taken to increase the knowledge

  14. Primary Care Resident Perceived Preparedness to Deliver Cross-cultural Care: An Examination of Training and Specialty Differences

    Science.gov (United States)

    Park, Elyse R.; Green, Alexander R.; Betancourt, Joseph R.; Weissman, Joel S.

    2007-01-01

    Objective Previous research has shown that resident physicians report differences in training across primary care specialties, although limited data exist on education in delivering cross-cultural care. The goals of this study were to identify factors that relate to primary care residents’ perceived preparedness to provide cross-cultural care and to explore the extent to which these perceptions vary across primary care specialties. Design Cross-sectional, national mail survey of resident physicians in their last year of training. Participants Eleven hundred fifty primary care residents specializing in family medicine (27%), internal medicine (23%), pediatrics (26%), and obstetrics/gynecology (OB/GYN) (24%). Results Male residents as well as those who reported having graduated from U.S. medical schools, access to role models, and a greater cross-cultural case mix during residency felt more prepared to deliver cross-cultural care. Adjusting for these demographic and clinical factors, family practice residents were significantly more likely to feel prepared to deliver cross-cultural care compared to internal medicine, pediatric, and OB/GYN residents. Yet, when the quantity of instruction residents reported receiving to deliver cross-cultural care was added as a predictor, specialty differences became nonsignificant, suggesting that training opportunities better account for the variability in perceived preparedness than specialty. Conclusions Across primary care specialties, residents reported different perceptions of preparedness to deliver cross-cultural care. However, this variation was more strongly related to training factors, such as the amount of instruction physicians received to deliver such care, rather than specialty affiliation. These findings underscore the importance of formal education to enhance residents’ preparedness to provide cross-cultural care. PMID:17516107

  15. Evaluation of knowledge change of internal medicine residents following a training program in smoking cessation

    International Nuclear Information System (INIS)

    Labib, N.A.; Radwan, G.N.; Salma, R.A.A.; Horeesh, N.A.

    2012-01-01

    One of the major barriers to smoking cessation practice is that many health professionals do not have the knowledge and skills on how to intervene. Objectives: To assess the effect of a training program on physicians' knowledge about tobacco dependence and cessation interventions. Subjects and Methods: A comprehensive training program was given to internal medicine residents in Cairo University Hospitals, Egypt during 2008-2009. An anonymous, 11- item questionnaire was administered before and after the training program. The training process was evaluated by participants' satisfaction using a 13- item checklist. The objective of the study was adequately explained to participants and their consensus was obtained with assured confidentiality. Results: A total of 163 internists entered the training program. Improvement in overall knowledge was evidenced by higher mean score in the post-test than pre-test (6.2 vs. 4.7; p<0.001). Significant improvement were seen in the participants' knowledge related to assessment of tobacco dependence (61% vs. 27%;p<0.001), interventions for smokers willing to quit (51.6 vs. 28.2%; p<0.001), interventions for smokers unwilling to quit (40.8 vs. 19.6%; p<0.001) and coping skills to handle withdrawal symptoms (52.9 vs. 30.7;p<0.001). Almost all participants reported that the training was very useful (96%) and applicable (85.6%) in their medical practices. Conclusions: Targeted training of health professionals has a potential to translate into improved smoking cessation counseling and to increase their inclination to intervene. Policy message: Continued medical education and regular/targeted training of health providers should be done. (author)

  16. Implementing the 2009 Institute of Medicine recommendations on resident physician work hours, supervision, and safety.

    Science.gov (United States)

    Blum, Alexander B; Shea, Sandra; Czeisler, Charles A; Landrigan, Christopher P; Leape, Lucian

    2011-01-01

    Long working hours and sleep deprivation have been a facet of physician training in the US since the advent of the modern residency system. However, the scientific evidence linking fatigue with deficits in human performance, accidents and errors in industries from aeronautics to medicine, nuclear power, and transportation has mounted over the last 40 years. This evidence has also spawned regulations to help ensure public safety across safety-sensitive industries, with the notable exception of medicine. In late 2007, at the behest of the US Congress, the Institute of Medicine embarked on a year-long examination of the scientific evidence linking resident physician sleep deprivation with clinical performance deficits and medical errors. The Institute of Medicine's report, entitled "Resident duty hours: Enhancing sleep, supervision and safety", published in January 2009, recommended new limits on resident physician work hours and workload, increased supervision, a heightened focus on resident physician safety, training in structured handovers and quality improvement, more rigorous external oversight of work hours and other aspects of residency training, and the identification of expanded funding sources necessary to implement the recommended reforms successfully and protect the public and resident physicians themselves from preventable harm. Given that resident physicians comprise almost a quarter of all physicians who work in hospitals, and that taxpayers, through Medicare and Medicaid, fund graduate medical education, the public has a deep investment in physician training. Patients expect to receive safe, high-quality care in the nation's teaching hospitals. Because it is their safety that is at issue, their voices should be central in policy decisions affecting patient safety. It is likewise important to integrate the perspectives of resident physicians, policy makers, and other constituencies in designing new policies. However, since its release, discussion of the

  17. How Entrustment Is Informed by Holistic Judgments Across Time in a Family Medicine Residency Program: An Ethnographic Nonparticipant Observational Study.

    Science.gov (United States)

    Sagasser, Margaretha H; Fluit, Cornelia R M G; van Weel, Chris; van der Vleuten, Cees P M; Kramer, Anneke W M

    2017-06-01

    Entrustment has mainly been conceptualized as delegating discrete professional tasks. Because residents provide most of their patient care independently, not all resident performance is visible to supervisors; the entrustment process involves more than granting discrete tasks. This study explored how supervisors made entrustment decisions based on residents' performance in a long-term family medicine training program. A qualitative nonparticipant observational study was conducted in 2014-2015 at competency-based family medicine residency programs in the Netherlands. Seven supervisor-resident pairs participated. During two days, one researcher observed first-year residents' patient encounters, debriefing sessions, and supervisor-resident educational meetings and interviewed them separately afterwards. Data were collected and analyzed using iterative, phenomenological inductive research methodology. The entrustment process developed over three phases. Supervisors based their initial entrustment on prior knowledge about the resident. In the ensuing two weeks, entrustment decisions regarding independent patient care were derived from residents' observed general competencies necessary for a range of health problems (clinical reasoning, decision making, relating to patients); medical knowledge and skills; and supervisors' intuition. Supervisors provided supervision during and after encounters. Once residents performed independently, supervisors kept reevaluating their decisions, informed by residents' overall growth in competencies rather than by adhering to a predefined set of tasks. Supervisors in family medicine residency training took a holistic approach to trust, based on general competencies, knowledge, skills, and intuition. Entrustment started before training and developed over time. Building trust is a mutual process between supervisor and resident, requiring a good working relationship.

  18. Global health training and international clinical rotations during residency: current status, needs, and opportunities.

    Science.gov (United States)

    Drain, Paul K; Holmes, King K; Skeff, Kelley M; Hall, Thomas L; Gardner, Pierce

    2009-03-01

    Increasing international travel and migration have contributed to globalization of diseases. Physicians today must understand the global burden and epidemiology of diseases, the disparities and inequities in global health systems, and the importance of cross-cultural sensitivity. To meet these needs, resident physicians across all specialties have expressed growing interest in global health training and international clinical rotations. More residents are acquiring international experience, despite inadequate guidance and support from most accreditation organizations and residency programs. Surveys of global health training, including international clinical rotations, highlight the benefits of global health training as well as the need for a more coordinated approach. In particular, international rotations broaden a resident's medical knowledge, reinforce physical examination skills, and encourage practicing medicine among underserved and multicultural populations. As residents recognize these personal and professional benefits, a strong majority of them seek to gain international clinical experience. In conclusion, with feasible and appropriate administrative steps, all residents can receive global health training and be afforded the accreditation and programmatic support to participate in safe international rotations. The next steps should address accreditation for international rotations and allowance for training away from continuity clinics by residency accreditation bodies, and stipend and travel support for six or more weeks of call-free elective time from residency programs.

  19. Resident career planning needs in internal medicine: a qualitative assessment.

    Science.gov (United States)

    Garcia, Rina L; Windish, Donna M; Rosenbaum, Julie R

    2010-12-01

    Few residency programs have centralized resources for career planning. As a consequence, little is known about residents' informational needs regarding career planning. To examine career preparation stressors, practical needs, and information that residents wished they were privy to when applying. In 2007 and 2008, we surveyed 163 recent graduates or graduating residents from 10 Yale-based and Yale-affiliated hospitals' internal medicine programs regarding their experiences with applying for positions after residency. We included questions about demographics, mentorship, stress of finding a job or fellowship, and open-ended questions to assess barriers and frustrations. Qualitative data were coded independently and a classification scheme was negotiated by consensus. A total of 89 residents or recent graduates responded, and 75% of them found career planning during residency training at least somewhat stressful. Themes regarding the application process included (1) knowledge about the process, (2) knowledge about career paths and opportunities, (3) time factors, (4) importance of adequate personal guidance and mentorship, and (5) self-knowledge regarding priorities and the desired outcome. Residents identified the following advice as most important: (1) start the process as early as possible and with a clear knowledge of the process timeline, (2) be clear about personal goals and priorities, and (3) be well-informed about a prospective employer and what that employer is looking for. Most residents felt career planning should be structured into the curriculum and should occur in the first year or throughout residency. This study highlights residents' desire for structured dissemination of information and counseling with regard to career planning during residency. Our data suggest that exposure to such resources may be beneficial as early as the first year of training.

  20. Determinants of internal medicine residents' choice in the canadian R4 Fellowship Match: A qualitative study

    Directory of Open Access Journals (Sweden)

    Kassam Narmin

    2011-06-01

    Full Text Available Abstract Background There is currently a discrepancy between Internal Medicine residents' decisions in the Canadian subspecialty fellowship match (known as the R4 match and societal need. Some studies have been published examining factors that influence career choices. However, these were either demographic factors or factors pre-determined by the authors' opinion as possibly being important to incorporate into a survey. Methods A qualitative study was undertaken to identify factors that determine the residents choice in the subspecialty (R4 fellowship match using focus group discussions involving third and fourth year internal medicine residents Results Based on content analysis of the discussion data, we identified five themes: 1 Practice environment including acuity of practice, ability to do procedures, lifestyle, job prospects and income 2 Exposure in rotations and to role models 3 Interest in subspecialty's patient population and common diseases 4 Prestige and respect of subspecialty 5 Fellowship training environment including fellowship program resources and length of training Conclusions There are a variety of factors that contribute to Internal Medicine residents' fellowship choice in Canada, many of which have been identified in previous survey studies. However, we found additional factors such as the resources available in a fellowship program, the prestige and respect of a subspecialty/career, and the recent trend towards a two-year General Internal Medicine fellowship in our country.

  1. Education on the Business of Plastic Surgery During Training: A Survey of Plastic Surgery Residents.

    Science.gov (United States)

    Ovadia, Steven A; Gishen, Kriya; Desai, Urmen; Garcia, Alejandro M; Thaller, Seth R

    2018-06-01

    Entrepreneurial skills are important for physicians, especially plastic surgeons. Nevertheless, these skills are not typically emphasized during residency training. Evaluate the extent of business training at plastic surgery residency programs as well as means of enhancing business training. A 6-question online survey was sent to plastic surgery program directors for distribution to plastic surgery residents. Responses from residents at the PGY2 level and above were included for analysis. Tables were prepared to present survey results. Hundred and sixty-six residents including 147 PGY2 and above residents responded to our survey. Only 43.5% reported inclusion of business training in their plastic surgery residency. A majority of residents reported they do not expect on graduation to be prepared for the business aspects of plastic surgery. Additionally, a majority of residents feel establishment of a formal lecture series on the business of plastic surgery would be beneficial. Results from our survey indicate limited training at plastic surgery programs in necessary business skills. Plastic surgery residency programs should consider incorporating or enhancing elements of business training in their curriculum. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  2. Factors associated with primary care residents' satisfaction with their training.

    Science.gov (United States)

    Randall, C S; Bergus, G R; Schlechte, J A; McGuinness, G; Mueller, C W

    1997-01-01

    Satisfaction is known to impact work performance, learning, recruitment, and retention. This study identifies the factors associated with primary care residents' satisfaction with their training. We used a cross-sectional survey based on the Price-Mueller model of job satisfaction. The model included 14 job characteristics, four personal characteristics, and four demographic factors. Data were collected in February and March 1996 from residents in three primary care training programs (family practice, pediatrics, and internal medicine) at a large academic medical center. The same standardized, self-administered questionnaires were used in all three departments. Seventy-five percent (n = 119) of the residents returned questionnaires. Five job characteristics were positively associated with resident satisfaction: continuity of care, autonomy, collegiality, work that encourages professional growth, and work group loyalty. Role conflict, a sixth job characteristic, was negatively associated with satisfaction. The personal characteristic of having an optimistic outlook on life was also positively associated with satisfaction. The model explained 66% of the variation in self-reported satisfaction. The satisfaction of the residents was significantly associated with six job characteristics and one personal factor. Interventions based on these job characteristics may increase resident satisfaction and may lead to better patient outcomes, better work performance, greater patient satisfaction, and more success in recruiting top students into a residency.

  3. A national survey of residents in combined Internal Medicine and Dermatology residency programs: educational experience and future plans.

    Science.gov (United States)

    Mostaghimi, Arash; Wanat, Karolyn; Crotty, Bradley H; Rosenbach, Misha

    2015-10-16

    In response to a perceived erosion of medical dermatology, combined internal medicine and dermatology programs (med/derm) programs have been developed that aim to train dermatologists who take care of medically complex patients. Despite the investment in these programs, there is currently no data with regards to the potential impact of these trainees on the dermatology workforce. To determine the experiences, motivations, and future plans of residents in combined med/derm residency programs. We surveyed residents at all United States institutions with both categorical and combined training programs in spring of 2012. Respondents used visual analog scales to rate clinical interests, self-assessed competency, career plans, and challenges. The primary study outcomes were comfort in taking care of patients with complex disease, future practice plans, and experience during residency. Twenty-eight of 31 med/derm residents (87.5%) and 28 of 91 (31%) categorical residents responded (overall response rate 46%). No significant differences were seen in self-assessed dermatology competency, or comfort in performing inpatient consultations, cosmetic procedures, or prescribing systemic agents. A trend toward less comfort in general dermatology was seen among med/derm residents. Med/derm residents were more likely to indicate career preferences for performing inpatient consultation and taking care of medically complex patients. Categorical residents rated their programs and experiences more highly. Med/derm residents have stronger interests in serving medically complex patients. Categorical residents are more likely to have a positive experience during residency. Future work will be needed to ascertain career choices among graduates once data are available.

  4. Effectiveness of a 2-year menopause medicine curriculum for obstetrics and gynecology residents.

    Science.gov (United States)

    Christianson, Mindy S; Washington, Chantel I; Stewart, Katherine I; Shen, Wen

    2016-03-01

    Previous work has shown American obstetrics and gynecology (OB/GYN) residents are lacking in menopause training. Our objective was to assess the effectiveness of a 2-year menopause medicine curriculum in improving OB/GYN residents' knowledge and self-assessed competency in menopause topics. We developed a menopause medicine-teaching curriculum for OB/GYN residents at our academic hospital-based residency program. The 2-year curriculum was composed of year 1: four 1-hour lectures and one 2-hour lab with cases presentations, and year 2: three 1-hour lectures and one 2-hour lab. Core topics included menopause physiology, hormone therapy, breast health, bone health, cardiovascular disease, and autoimmune disease. Pre- and posttests assessed resident knowledge and comfort in core topics, and a pre- and postcurriculum survey assessed utility and learning satisfaction. From July 2011 to June 2013, 34 OB/GYN residents completed the menopause curriculum annually with an average attendance at each module of 23 residents. Pre-/posttest scores improved from a mean pretest score of 57.3% to a mean posttest score of 78.7% (P menopause patients with 75.8% reporting feeling "barely comfortable" and 8.4% feeling "not at all comfortable." After the 2-year curriculum, 85.7% reported feeling "comfortable/very comfortable" taking care of menopause patients. The majority of residents (95.2%) reported the menopause curriculum was "extremely useful." A 2-year menopause medicine curriculum for OB/GYN residents utilizing lectures and a lab with case studies is an effective modality to improve resident knowledge required to manage menopause patients.

  5. The Computer Book of the Internal Medicine Resident: competence acquisition and achievement of learning objectives.

    Science.gov (United States)

    Oristrell, J; Oliva, J C; Casanovas, A; Comet, R; Jordana, R; Navarro, M

    2014-01-01

    The Computer Book of the Internal Medicine resident (CBIMR) is a computer program that was validated to analyze the acquisition of competences in teams of Internal Medicine residents. To analyze the characteristics of the rotations during the Internal Medicine residency and to identify the variables associated with the acquisition of clinical and communication skills, the achievement of learning objectives and resident satisfaction. All residents of our service (n=20) participated in the study during a period of 40 months. The CBIMR consisted of 22 self-assessment questionnaires specific for each rotation, with items on services (clinical workload, disease protocolization, resident responsibilities, learning environment, service organization and teamwork) and items on educational outcomes (acquisition of clinical and communication skills, achievement of learning objectives, overall satisfaction). Associations between services features and learning outcomes were analyzed using bivariate and multivariate analysis. An intense clinical workload, high resident responsibilities and disease protocolization were associated with the acquisition of clinical skills. High clinical competence and teamwork were both associated with better communication skills. Finally, an adequate learning environment was associated with increased clinical competence, the achievement of educational goals and resident satisfaction. Potentially modifiable variables related with the operation of clinical services had a significant impact on the acquisition of clinical and communication skills, the achievement of educational goals, and resident satisfaction during the specialized training in Internal Medicine. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  6. Intensive Care Unit Rotations and Predictors of Career Choice in Pulmonary/Critical Care Medicine: A Survey of Internal Medicine Residency Directors

    Directory of Open Access Journals (Sweden)

    Daniel J. Minter

    2018-01-01

    Full Text Available Background. The United States (US is experiencing a growing shortage of critical care medicine (CCM trained physicians. Little is known about the exposures to CCM experienced by internal medicine (IM residents or factors that may influence their decision to pursue a career in pulmonary/critical care medicine (PCCM. Methods. We conducted a survey of US IM residency program directors (PDs and then used multivariable logistic regression to identify factors that were predictive of residency programs with a higher percentage of graduates pursuing careers in PCCM. Results. Of the 249 PDs contacted, 107 (43% completed our survey. University-sponsored programs more commonly had large ICUs (62.3% versus 42.2%, p=0.05, primary medical ICUs (63.9% versus 41.3%, p=0.03, and closed staffing models (88.5% versus 41.3%, p20 beds, residents serving as code leaders, and greater proportion of graduates pursuing specialization. Conclusions. While numerous differences exist between the ICU rotations at community- and university-sponsored IM residencies, the percentage of graduates specializing in PCCM was similar. Exposure to larger ICUs, serving as code leaders, and higher rates of specialization were predictive of a career choice in PCCM.

  7. Competency Assessment in Family Medicine Residency: Observations, Knowledge-Based Examinations, and Advancement.

    Science.gov (United States)

    Mainous, Arch G; Fang, Bo; Peterson, Lars E

    2017-12-01

    The Family Medicine (FM) Milestones are competency-based assessments of residents in key dimensions relevant to practice in the specialty. Residency programs use the milestones in semiannual reviews of resident performance from the time of entry into the program to graduation. Using a national sample, we investigated the relationship of FM competency-based assessments to resident progress and the complementarity of milestones with knowledge-based assessments in FM residencies. We used midyear and end-of-year milestone ratings for all FM residents in Accreditation Council for Graduate Medical Education-accredited programs during academic years 2014-2015 and 2015-2016. The milestones contain 22 items across 6 competencies. We created a summative index across the milestones. The American Board of Family Medicine database provided resident demographics and in-training examination (ITE) scores. We linked information to the milestone data. The sample encompassed 6630 FM residents. The summative milestone index increased, on average, for each cohort (postgraduate year 1 [PGY-1] to PGY-2 and PGY-2 to PGY-3) at each assessment. The correlation between the milestone index that excluded the medical knowledge milestone and ITE scores was r  = .195 ( P  ITE scores and composite milestone assessments were higher for residents who advanced than for those who did not. Competency-based assessment using the milestones for FM residents seems to be a viable multidimensional tool to assess the successful progression of residents.

  8. Support for and aspects of use of educational games in family medicine and internal medicine residency programs in the US: a survey.

    Science.gov (United States)

    Akl, Elie A; Gunukula, Sameer; Mustafa, Reem; Wilson, Mark C; Symons, Andrew; Moheet, Amir; Schünemann, Holger J

    2010-03-25

    The evidence supporting the effectiveness of educational games in graduate medical education is limited. Anecdotal reports suggest their popularity in that setting. The objective of this study was to explore the support for and the different aspects of use of educational games in family medicine and internal medicine residency programs in the United States. We conducted a survey of family medicine and internal medicine residency program directors in the United States. The questionnaire asked the program directors whether they supported the use of educational games, their actual use of games, and the type of games being used and the purpose of that use. Of 434 responding program directors (52% response rate), 92% were in support of the use of games as an educational strategy, and 80% reported already using them in their programs. Jeopardy like games were the most frequently used games (78%). The use of games was equally popular in family medicine and internal medicine residency programs and popularity was inversely associated with more than 75% of residents in the program being International Medical Graduates. The percentage of program directors who reported using educational games as teaching tools, review tools, and evaluation tools were 62%, 47%, and 4% respectively. Given a widespread use of educational games in the training of medical residents, in spite of limited evidence for efficacy, further evaluation of the best approaches to education games should be explored.

  9. Support for and aspects of use of educational games in family medicine and internal medicine residency programs in the US: a survey

    Directory of Open Access Journals (Sweden)

    Wilson Mark C

    2010-03-01

    Full Text Available Abstract Background The evidence supporting the effectiveness of educational games in graduate medical education is limited. Anecdotal reports suggest their popularity in that setting. The objective of this study was to explore the support for and the different aspects of use of educational games in family medicine and internal medicine residency programs in the United States. Methods We conducted a survey of family medicine and internal medicine residency program directors in the United States. The questionnaire asked the program directors whether they supported the use of educational games, their actual use of games, and the type of games being used and the purpose of that use. Results Of 434 responding program directors (52% response rate, 92% were in support of the use of games as an educational strategy, and 80% reported already using them in their programs. Jeopardy like games were the most frequently used games (78%. The use of games was equally popular in family medicine and internal medicine residency programs and popularity was inversely associated with more than 75% of residents in the program being International Medical Graduates. The percentage of program directors who reported using educational games as teaching tools, review tools, and evaluation tools were 62%, 47%, and 4% respectively. Conclusions Given a widespread use of educational games in the training of medical residents, in spite of limited evidence for efficacy, further evaluation of the best approaches to education games should be explored.

  10. Allocation of Internal Medicine Resident Time in a Swiss Hospital: A Time and Motion Study of Day and Evening Shifts.

    Science.gov (United States)

    Wenger, Nathalie; Méan, Marie; Castioni, Julien; Marques-Vidal, Pedro; Waeber, Gérard; Garnier, Antoine

    2017-04-18

    Little current evidence documents how internal medicine residents spend their time at work, particularly with regard to the proportions of time spent in direct patient care versus using computers. To describe how residents allocate their time during day and evening hospital shifts. Time and motion study. Internal medicine residency at a university hospital in Switzerland, May to July 2015. 36 internal medicine residents with an average of 29 months of postgraduate training. Trained observers recorded the residents' activities using a tablet-based application. Twenty-two activities were categorized as directly related to patients, indirectly related to patients, communication, academic, nonmedical tasks, and transition. In addition, the presence of a patient or colleague and use of a computer or telephone during each activity was recorded. Residents were observed for a total of 696.7 hours. Day shifts lasted 11.6 hours (1.6 hours more than scheduled). During these shifts, activities indirectly related to patients accounted for 52.4% of the time, and activities directly related to patients accounted for 28.0%. Residents spent an average of 1.7 hours with patients, 5.2 hours using computers, and 13 minutes doing both. Time spent using a computer was scattered throughout the day, with the heaviest use after 6:00 p.m. The study involved a small sample from 1 institution. At this Swiss teaching hospital, internal medicine residents spent more time at work than scheduled. Activities indirectly related to patients predominated, and about half the workday was spent using a computer. Information Technology Department and Department of Internal Medicine of Lausanne University Hospital.

  11. Factors influencing selection of internal medicine residency--a prospective study.

    Science.gov (United States)

    Pereg, David; Gronich, Naomi; Lishner, Michael

    2006-08-01

    Recently, the popularity of internal medicine residency has been decreasing. We studied the effect of an improved working environment and a decrease in residents' workload on the selection of internal medicine residency. An organizational diagnosis team joined our department and identified several causes for residents' heavy workload. These findings were subsequently discussed in a workshop and led to a modification of the daily routine and a parallel decrease in workload and rise in residents' satisfaction. Following these changes, the demand for residency in our department rose. We conclude that an improvement in the working environment and workload during residency increases the residents' satisfaction and the demand for residency in internal medicine.

  12. Feasibility of an innovative third-year chief resident system: an internal medicine residency leadership study

    Directory of Open Access Journals (Sweden)

    Victor O. Kolade

    2014-07-01

    Full Text Available Introduction: The role of the internal medicine chief resident includes various administrative, academic, social, and educational responsibilities, fulfillment of which prepares residents for further leadership tasks. However, the chief resident position has historically only been held by a few residents. As fourth-year chief residents are becoming less common, we considered a new model for rotating third-year residents as the chief resident. Methods: Online surveys were given to all 29 internal medicine residents in a single university-based program after implementation of a leadership curriculum and specific job description for the third-year chief resident. Chief residents evaluated themselves on various aspects of leadership. Participation was voluntary. Descriptive statistics were generated using SPSS version 21. Results: Thirteen junior (first- or second-year resident responses reported that the chief residents elicited input from others (mean rating 6.8, were committed to the team (6.8, resolved conflict (6.7, ensured efficiency, organization and productivity of the team (6.7, participated actively (7.0, and managed resources (6.6. Responses from senior residents averaged 1 point higher for each item; this pattern repeated itself in teaching evaluations. Chief resident self-evaluators were more comfortable running a morning report (8.4 than with being chief resident (5.8. Conclusion: The feasibility of preparing internal medicine residents for leadership roles through a rotating PGY-3 (postgraduate year chief residency curriculum was explored at a small internal medicine residency, and we suggest extending the study to include other programs.

  13. Are Simulation Stethoscopes a Useful Adjunct for Emergency Residents' Training on High-fidelity Mannequins?

    Science.gov (United States)

    Warrington, Steven J; Beeson, Michael S; Fire, Frank L

    2013-05-01

    Emergency medicine residents use simulation training for many reasons, such as gaining experience with critically ill patients and becoming familiar with disease processes. Residents frequently criticize simulation training using current high-fidelity mannequins due to the poor quality of physical exam findings present, such as auscultatory findings, as it may lead them down an alternate diagnostic or therapeutic pathway. Recently wireless remote programmed stethoscopes (simulation stethoscopes) have been developed that allow wireless transmission of any sound to a stethoscope receiver, which improves the fidelity of a physical examination and the simulation case. Following institutional review committee approval, 14 PGY1-3 emergency medicine residents were assessed during 2 simulation-based cases using pre-defined scoring anchors on multiple actions, such as communication skills and treatment decisions (Appendix 1). Each case involved a patient presenting with dyspnea requiring management based off physical examination findings. One case was a patient with exacerbation of heart failure, while the other was a patient with a tension pneumothorax. Each resident was randomized into a case associated with the simulation stethoscope. Following the cases residents were asked to fill out an evaluation questionnaire. Residents perceived the most realistic physical exam findings on those associated with the case using the simulation stethoscope (13/14, 93%). Residents also preferred the simulation stethoscope as an adjunct to the case (13/14, 93%), and they rated the simulation stethoscope case to have significantly more realistic auscultatory findings (4.4/5 vs. 3.0/5 difference of means 1.4, p=0.0007). Average scores of residents were significantly better in the simulation stethoscope-associated case (2.5/3 vs. 2.3/3 difference of means 0.2, p=0.04). There was no considerable difference in the total time taken per case. A simulation stethoscope may be a useful adjunct to

  14. Competency-based education and training in internal medicine.

    Science.gov (United States)

    Weinberger, Steven E; Pereira, Anne G; Iobst, William F; Mechaber, Alex J; Bronze, Michael S

    2010-12-07

    Recent efforts to improve medical education include adopting a new framework based on 6 broad competencies defined by the Accreditation Council for Graduate Medical Education. In this article, the Alliance for Academic Internal Medicine Education Redesign Task Force II examines the advantages and challenges of a competency-based educational framework for medical residents. Efforts to refine specific competencies by developing detailed milestones are described, and examples of training program initiatives using a competency-based approach are presented. Meeting the challenges of a competency-based framework and supporting these educational innovations require a robust faculty development program. Challenges to competency-based education include teaching and evaluating the competencies related to practice-based learning and improvement and systems-based practice, as well as implementing a flexible time frame to achieve competencies. However, the Alliance for Academic Internal Medicine Education Redesign Task Force II does not favor reducing internal medicine training to less than 36 months as part of competency-based education. Rather, the 36-month time frame should allow for remediation to address deficiencies in achieving competencies and for diverse enrichment experiences in such areas as quality of care and practice improvement for residents who have demonstrated skills in all required competencies.

  15. Training gaps for pediatric residents planning a career in primary care: a qualitative and quantitative study.

    Science.gov (United States)

    Rosenberg, Adam A; Kamin, Carol; Glicken, Anita Duhl; Jones, M Douglas

    2011-09-01

    Resident training in pediatrics currently entails similar training for all residents in a fragmented curriculum with relatively little attention to the career plans of individual residents. To explore strengths and gaps in training for residents planning a career in primary care pediatrics and to present strategies for addressing the gaps. Surveys were sent to all graduates of the University of Colorado Denver Pediatric Residency Program (2003-2006) 3 years after completion of training. Respondents were asked to evaluate aspects of their training, using a 5-point Likert scale and evaluating each item ranging from "not at all well prepared" to "extremely well prepared" for their future career. In addition, focus groups were conducted with practitioners in 8 pediatric practices in Colorado. Sessions were transcribed and hand coded by 2 independent coders. Survey data identified training in behavior and development (mean score, 3.72), quality improvement and patient safety strategies (mean, 3.57), and practice management (mean, 2.46) as the weakest aspects of training. Focus groups identified deficiencies in training in mental health, practice management, behavioral medicine, and orthopedics. Deficiencies noted in curriculum structure were lack of residents' long-term continuity of relationships with patients; the need for additional training in knowledge, skills, and attitudes needed for primary care (perhaps even a fourth year of training); and a training structure that facilitates greater resident autonomy to foster development of clinical capability and self-confidence. Important gaps were identified in the primary care training of pediatric residents. These data support the need to develop more career-focused training.

  16. Psychosomatic Medicine for Non-Psychiatric Residents: Video Education and Incorporation of Technology.

    Science.gov (United States)

    Saunders, J; Gopalan, P; Puri, N; Azzam, P N; Zhou, L; Ghinassi, F; Jain, A; Travis, M; Ryan, N D

    2015-12-01

    Psychiatric education for non-psychiatric residents varies between training programs, and may affect resident comfort with psychiatric topics. This study's goals were to identify non-psychiatric residents' comfort with psychiatric topics and to test the effectiveness of a video intervention. Residents in various departments were given a survey. They were asked to rank their comfort level with multiple psychiatric topics, answer questions about medical decision making capacity (MDMC), watch a 15-min video about MDMC, and answer a post-test section. In total, 91 Internal Medicine, General Surgery, and Obstetrics and Gynecology residents responded to the study. Of the 91 residents, 55 completed the pre- and post-test assessments. There was no significant difference in correct responses. Residents' comfort levels were assessed, and a significant improvement in comfort level with MDMC was found. This study highlights potential opportunities for psychiatric education, and suggests brief video interventions can increase resident physicians' comfort with a psychiatric topic.

  17. Changing the Formula of Residents' Work Hours in Internal Medicine: Moving From “Years in Training” to “Hours in Training”

    Science.gov (United States)

    Mansi, Ishak A

    2011-01-01

    Background In a recent report, the Institute of Medicine recommended more restrictions on residents' working hours. Several problems exist with a system that places a weekly limit on resident duty hours: (1) it assumes the presence of a linear relationship between hours of work and patient safety; (2) it fails to consider differences in intensity among programs; and (3) it does not address increases in the scientific content of medicine, and it places the burden of enforcing the duty hour limits on the Accreditation Council for Graduate Medical Education. Proposal An innovative method of calculating credit hours for graduate medical education would shift the focus from “years of residency” to “hours of residency.” For example, internal medicine residents would be requested to spend 8640 hours of total training hours (assuming 60 hours per week for 48 weeks annually) instead of the traditional 3 years. This method of counting training hours is used by other professions, such as the Intern Development Program of the National Council of Architectural Registration Boards. The proposed approach would allow residents and program directors to pace training based on individual capabilities. Standards for resident education should include the average number of patients treated in each setting (inpatient or outpatient). A possible set of “multipliers” based on these parameters, and possibly others such as resident evaluation, is devised to calculate the “final adjusted accredited hours” that count toward graduation. Anticipated Benefits Substituting “years of training” with “hours of training” may resolve many of the concerns with the current residency education model, as well as adapt to the demands of residents' personal lives. It also may allow residents to pace their training according to their capabilities and learning styles, and contribute to reflective learning and better quality education. PMID:22379516

  18. Multidimensional Attitudes of Emergency Medicine Residents Toward Older Adults

    Directory of Open Access Journals (Sweden)

    Teresita M. Hogan

    2014-07-01

    Full Text Available Introduction: The demands of our rapidly expanding older population strain many emergency departments (EDs, and older patients experience disproportionately high adverse health outcomes. Trainee attitude is key in improving care for older adults. There is negligible knowledge of baseline emergency medicine (EM resident attitudes regarding elder patients. Awareness of baseline attitudes can serve to better structure training for improved care of older adults. The objective of the study is to identify baseline EM resident attitudes toward older adults using a validated attitude scale and multidimensional analysis. Methods: Six EM residencies participated in a voluntary anonymous survey delivered in summer and fall 2009. We used factor analysis using the principal components method and Varimax rotation, to analyze attitude interdependence, translating the 21 survey questions into 6 independent dimensions. We adapted this survey from a validated instrument by the addition of 7 EM-specific questions to measures attitudes relevant to emergency care of elders and the training of EM residents in the geriatric competencies. Scoring was performed on a 5-point Likert scale. We compared factor scores using student t and ANOVA. Results: 173 EM residents participated showing an overall positive attitude toward older adults, with a factor score of 3.79 (3.0 being a neutral score. Attitudes trended to more negative in successive post-graduate year (PGY levels. Conclusion: EM residents demonstrate an overall positive attitude towards the care of older adults. We noted a longitudinal hardening of attitude in social values, which are more negative in successive PGY-year levels. [West J Emerg Med. 2014;15(4:511–517.

  19. Combining clinical microsystems and an experiential quality improvement curriculum to improve residency education in internal medicine.

    Science.gov (United States)

    Tess, Anjala V; Yang, Julius J; Smith, C Christopher; Fawcett, Caitlin M; Bates, Carol K; Reynolds, Eileen E

    2009-03-01

    Beth Israel Deaconess Medical Center's internal medicine residency program was admitted to the new Education Innovation Project accreditation pathway of the Accreditation Council of Graduate Medical Education to begin in July 2006. The authors restructured the inpatient medical service to create clinical microsystems in which residents practice throughout residency. Program leadership then mandated an active curriculum in quality improvement based in those microsystems. To provide the experience to every graduating resident, a core faculty in patient safety was trained in the basics of quality improvement. The authors hypothesized that such changes would increase the number of residents participating in quality improvement projects, improve house officer engagement in quality improvement work, enhance the culture of safety the residents perceive in their training environment, improve work flow on the general medicine ward rotations, and improve the overall educational experience for the residents on ward rotations.The authors describe the first 18 months of the intervention (July 2006 to January 2008). The authors assessed attitudes and the educational experience with surveys and evaluation forms. After the intervention, the authors documented residents' participation in projects that overlapped with hospital priorities. More residents reported roles in designing and implementing quality improvement changes. Residents also noted greater satisfaction with the quality of care they deliver. Fewer residents agreed or strongly agreed that the new admitting system interfered with communication. Ongoing residency program assessment showed an improved perception of workload, and educational ratings of rotations improved. The changes required few resources and can be transported to other settings.

  20. Maintaining a Twitter Feed to Advance an Internal Medicine Residency Program’s Educational Mission

    Science.gov (United States)

    Narang, Akhil; Arora, Vineet M

    2015-01-01

    Background Residency programs face many challenges in educating learners. The millennial generation’s learning preferences also force us to reconsider how to reach physicians in training. Social media is emerging as a viable tool for advancing curricula in graduate medical education. Objective The authors sought to understand how social media enhances a residency program’s educational mission. Methods While chief residents in the 2013-2014 academic year, two of the authors (PB, AN) maintained a Twitter feed for their academic internal medicine residency program. Participants included the chief residents and categorical internal medicine house staff. Results At the year’s end, the authors surveyed residents about uses and attitudes toward this initiative. Residents generally found the chief residents’ tweets informative, and most residents (42/61, 69%) agreed that Twitter enhanced their overall education in residency. Conclusions Data from this single-site intervention corroborate that Twitter can strengthen a residency program’s educational mission. The program’s robust following on Twitter outside of the home program also suggests a need for wider adoption of social media in graduate medical education. Improved use of data analytics and dissemination of these practices to other programs would lend additional insight into social media’s role in improving residents’ educational experiences. PMID:27731845

  1. Training in radiological protection of residents

    International Nuclear Information System (INIS)

    Vicent, M. D.; Fernandez, M. J.; Olmos, C.; Isidoro, B.; Espana, M. L.; Arranz, L.

    2013-01-01

    In compliance with the current laws, radiation protection (RP) training is required during the formative programs of certain Health Sciences specialties. Laws entrust to official bodies in specialized training the adoption of necessary measures to coordinate and ensure a correct implementation. The aim of this study is to describe Community of Madrid experience in RP training to specialists during their formative programs, and to determine the number of residents trained and analyze their satisfaction level with the training. A descriptive cross-sectional study was performed, including all training specialists from the Community of Madrid during the 2007-2011 period. We determined the number of residents trained per year and we evaluated their satisfaction level with the training through a survey. A total of 55 training courses were carried out and 5820 residents have been trained during the 2007-2011 period. the student satisfaction level with the training has increased gradually from 6.1 points in 2007 to 7.0 points in 2011. The development of the RP formative program for residents in the Community of Madrid has meant the start up o the necessary official mechanisms to ensure the quality and adequacy of training in this area, covering the formative needs of the collective. (Author)

  2. Ethics education in family medicine training in the United States: a national survey.

    Science.gov (United States)

    Manson, Helen M; Satin, David; Nelson, Valerie; Vadiveloo, Thenmalar

    2014-01-01

    Although professional organizations endorse ethics education in family medicine training, there is little published evidence that ethics teaching occurs. This survey collated data on the aims, content, pedagogical methods, assessment, and barriers relating to formal ethics education in family medicine residency programs in the United States. A questionnaire surveyed all 445 family medicine residency programs in the United States. Forty percent of programs responded (178/445). Of these, 95% formally teach at least one ethics topic, 68.2% teach six or more topics, and 7.1% teach all 13 core topics specified in the questionnaire. Programs show variation, providing between zero to 100 hours' ethics education over the 3 years of residency training. Of the responding programs, 3.5% specify well-defined aims for ethics teaching, 25.9% designate overall responsibility for the ethics curriculum to one individual, and 33.5% formally assess ethics competencies. The most frequent barriers to ethics education are finding time in residents' schedules (59.4%) and educator expertise (21.8%). Considerable variation in ethics education is apparent in both curricular content and delivery among family medicine residency programs in the United States. Additional findings included a lack of specification of explicit curricular aims for ethics teaching allied to ACGME or AAFP competencies, a tendency not to designate one faculty member with lead responsibility for ethics teaching in the residency program, and a lack of formal assessment of ethics competencies. This has occurred in the context of an absence of robust assessment of ethics competencies at board certification level.

  3. Impact of a competency based curriculum on quality improvement among internal medicine residents.

    Science.gov (United States)

    Fok, Mark C; Wong, Roger Y

    2014-11-28

    Teaching quality improvement (QI) principles during residency is an important component of promoting patient safety and improving quality of care. The literature on QI curricula for internal medicine residents is limited. We sought to evaluate the impact of a competency based curriculum on QI among internal medicine residents. This was a prospective, cohort study over four years (2007-2011) using pre-post curriculum comparison design in an internal medicine residency program in Canada. Overall 175 post-graduate year one internal medicine residents participated. A two-phase, competency based curriculum on QI was developed with didactic workshops and longitudinal, team-based QI projects. The main outcome measures included self-assessment, objective assessment using the Quality Improvement Knowledge Assessment Tool (QIKAT) scores to assess QI knowledge, and performance-based assessment via presentation of longitudinal QI projects. Overall 175 residents participated, with a response rate of 160/175 (91%) post-curriculum and 114/175 (65%) after conducting their longitudinal QI project. Residents' self-reported confidence in making changes to improve health increased and was sustained at twelve months post-curriculum. Self-assessment scores of QI skills improved significantly from pre-curriculum (53.4 to 69.2 percent post-curriculum [p-value 0.002]) and scores were sustained at twelve months after conducting their longitudinal QI projects (53.4 to 72.2 percent [p-value 0.005]). Objective scores using the QIKAT increased post-curriculum from 8.3 to 10.1 out of 15 (p-value for difference value for difference from pre-curriculum based assessment occurred via presentation of all projects at the annual QI Project Podium Presentation Day. The competency based curriculum on QI improved residents' QI knowledge and skills during residency training. Importantly, residents perceived that their QI knowledge improved after the curriculum and this also correlated to improved QIKAT

  4. Reproductive Psychiatry Residency Training: A Survey of Psychiatric Residency Program Directors.

    Science.gov (United States)

    Osborne, Lauren M; MacLean, Joanna V; Barzilay, Erin Murphy; Meltzer-Brody, Samantha; Miller, Laura; Yang, Sarah Nagle

    2018-04-01

    The reproductive life cycle has unique influences on the phenotypic expression of mental illness in women. Didactic and clinical training focused on these sex-specific influences should be a vital component of the education of future psychiatrists. The authors sought to determine the current state of and attitudes toward reproductive psychiatry in resident education. The authors administered a web-based survey to psychiatry residency training directors. They assessed the availability of both mandated and optional didactic and clinical training experiences in reproductive psychiatry. Fifty residency program directors answered the survey, for a response rate of 28%. More than half of residency program directors (59%) reported requiring some training in reproductive psychiatry. Both the breadth and depth of topics covered varied greatly among programs. Lack of time (48%) and lack of qualified faculty (26%) were the most frequently cited barriers to more training. Only 40% of residency directors surveyed agreed that all residents should be competent in reproductive psychiatry. These findings suggest that specific training in reproductive psychiatry is inconsistent in US residency programs, and that training that does exist varies considerably in clinical time and content. Given that women comprise more than 50% of all psychiatric patients and most women will menstruate, give birth, and undergo menopause, future psychiatrists would benefit from more systematic instruction in this area. The authors propose the development of a national, standardized reproductive psychiatry curriculum to address this gap and aid in producing psychiatrists competent to treat women at all stages of life.

  5. Curricula and Organization of Primary Care Residencies in Internal Medicine.

    Science.gov (United States)

    Eisenberg, John M.

    1980-01-01

    The organization and curricula of internal medicine residencies programs that emphasize primary care are described and compared with traditional residencies in internal medicine. It is noted that primary care residents spend more time in ambulatory care and are allowed more electives in specialties outside of internal medicine. Out-of-hospital…

  6. Emergency medicine resident well-being: stress and satisfaction.

    Science.gov (United States)

    Hoonpongsimanont, W; Murphy, M; Kim, C H; Nasir, D; Compton, S

    2014-01-01

    Emergency medicine (EM) residents are exposed to many work-related stressors, which affect them both physically and emotionally. It is unknown, however, how EM residents perceive the effect of these stressors on their well-being and how often they use unhealthy coping mechanisms to manage stress. To evaluate EM residents' perceptions of stressors related to their overall well-being and the prevalence of various coping mechanisms. An online survey instrument was developed to gauge resident stress, satisfaction with current lifestyle, stress coping mechanisms and demographics. A stratified random sample of EM residents from three postgraduate years (PGY-I, PGY-II and PGY-III) was obtained. Descriptive statistics and one-way analysis of variance were used to compare residents across PGY level. There were 120 potential participants in each of the three PGYs. The overall response rate was 30% (109) with mean age of 30 and 61% were male. On a 0-4 scale (0 = completely dissatisfied), respondents in PGY-I reported significantly less satisfaction with lifestyle than those in PGY-II and III (mean rating: 1.29, 1.66 and 1.70, respectively; P stress categories: work relationships (1.37), work environment (1.10) and response to patients (1.08). Residents reported exercise (94%), hobbies (89%) and use of alcohol (71%) as coping methods. Residents reported low satisfaction with current lifestyle. This dissatisfaction was unrelated to perceived work-related stress. Some undesirable coping methods were prevalent, suggesting that training programs could focus on promotion of healthy group activities.

  7. Assessing the performance and satisfaction of medical residents utilizing standardized patient versus mannequin-simulated training

    Directory of Open Access Journals (Sweden)

    Alsaad AA

    2017-07-01

    Full Text Available Ali A Alsaad,1 Swetha Davuluri,2 Vandana Y Bhide,3 Amy M Lannen,4 Michael J Maniaci3 1Department of Internal Medicine, Mayo Clinic, 2University of Miami, Coral Gables, 3Division of Hospital Internal Medicine, 4J. Wayne and Delores Barr Weaver Simulation Center, Mayo Clinic, Jacksonville, FL, USA Background: Conducting simulations of rapidly decompensating patients are a key part of internal medicine (IM residency training. Traditionally, mannequins have been the simulation tool used in these scenarios. Objective: To compare IM residents’ performance and assess realism in specific-simulated decompensating patient scenarios using standardized patients (SPs as compared to mannequin. Methods: Nineteen IM residents were randomized to undergo simulations using either a mannequin or an SP. Each resident in the two groups underwent four different simulation scenarios (calcium channel blocker overdose, severe sepsis, severe asthma exacerbation, and acute bacterial meningitis. Residents completed pretest and post-test evaluations as well as a questionnaire to assess the reality perception (realism score. Results: Nine residents completed mannequin-based scenarios, whereas 10 completed SP-based scenarios. Improvement in the post-test scores was seen in both groups. However, there were significantly higher post-test scores achieved with SP simulations in three out of the four scenarios (P=0.01. When compared with the mannequin group, the SP simulation group showed a significantly higher average realism score (P=0.002. Conclusions: Applying SP-based specific-simulation scenarios in IM residency training may result in better performance and a higher sense of a realistic experience by medical residents. Keywords: simulation, standardized patient, satisfaction, mannequin, assessment, resident education

  8. Pediatric dermatology training during residency: a survey of the 2014 graduating residents.

    Science.gov (United States)

    Akhavan, Alaleh; Murphy-Chutorian, Blair; Friedman, Adam

    2015-01-01

    Knowledge of pediatric dermatology is considered a core competency of dermatology training and should be expected of all practicing dermatologists. While the numbers of both pediatric dermatology fellowships and board certified pediatric dermatologists in the workforce have increased over the years, recent reports suggest that there is a gap in pediatric dermatology education during dermatology residency. The goal of this study is to assess the current state of pediatric education during residency, as well as the clinical experience, satisfaction and expectations of graduating dermatology residents. A 31-question self-report survey was distributed electronically to 294 third-year dermatology residents with questions pertaining to demographics, didactic education, resident experience in pediatric dermatology training, satisfaction with pediatric training and future plans. One hundred and twenty-three residents responded (41.8% response rate) representing approximately 29.1% of the total number of graduating residents. 69 (56.1%) residents reported academic time specifically devoted to pediatric dermatology, the majority (79.7%) of which was led by pediatric dermatologists. 82% of residents reported dedicated pediatric dermatology clinics at their program. 86.8% of respondents felt that their training in pediatric dermatology will allow them to confidently see pediatric dermatology patients in practice. This survey highlights a promising state of pediatric dermatology training among current graduating dermatology residents. The majority of current graduating dermatology residents are satisfied with their pediatric dermatology education, feel confident treating pediatric patients, and plan to see pediatric patients in clinical practice. © 2015 Wiley Periodicals, Inc.

  9. Do community medicine residency trainees learn through journal club? An experience from a developing country

    Directory of Open Access Journals (Sweden)

    Kadir Muhammad

    2006-08-01

    Full Text Available Abstract Background Journal clubs are an internationally recognized teaching tool in many postgraduate medical education fields. In developing countries lack of funds for current print materials may have limited journal club use. But with advancing information technology trainees in developing countries increasingly have more access to high quality journals online. However, we are aware of no studies describing journal club existence and effectiveness in postgraduate medical training in Pakistan. Also we have found no published effectiveness studies of this teaching modality in Community Medicine (Public Health in any country. This study evaluated the effectiveness of Community Medicine (Public Health Resident Journal Club (CMR-JC in Aga Khan University, Pakistan using international criteria for successful journal clubs (2 years continuous existence and more than 50% attendance and examining resident and alumni satisfaction. Methods Journal club effectiveness criteria were searched using electronic search databases. Departmental records were reviewed from September1999–September 2005. Ninety percent of residents and alumni of Community Medicine Residency Programme participated voluntarily in a confidential survey. Results The CMR-JC was regularly conducted. More than 95% of residents attended. (Total residents in the CMR-Programme: 32. Twenty-seven out of 29 current residents/alumni responded to the anonymous questionnaire. Acquisition of critical appraisal skills (23 respondents and keeping up with current literature (18 respondents were the two most important objectives achieved. Respondents recommended improved faculty participation and incorporating a structured checklist for article review. Conclusion CMR-JC fulfils criteria for effective journal clubs. Residents and alumni agree CMR-JC meets its objectives. Incorporating suggested recommendations will further improve standards. The journal club learning modality should be included in

  10. Correlation of United States Medical Licensing Examination and Internal Medicine In-Training Examination performance.

    Science.gov (United States)

    Perez, Jose A; Greer, Sharon

    2009-12-01

    The Internal Medicine In-Training Examination (ITE) is administered during residency training in the United States as a self-assessment and program assessment tool. Performance on this exam correlates with outcome on the American Board of Internal Medicine Certifying examination. Internal Medicine Program Directors use the United States Medical Licensing Examination (USMLE) to make decisions in recruitment of potential applicants. This study was done to determine a correlation of USMLE Steps 1, 2 and 3 results with ITE scores in each level of Internal Medicine training. A retrospective review of all residents graduating from an Internal Medicine program from 1999 to 2006 was done. Subjects included had data for all USMLE Steps and ITE during all years of training. Thirty-one subjects were included in the study. Correlations of USMLE Steps 1, 2 and 3 were done with ITE scores (percent correct) in each year of training. Pearson's correlation coefficient (r) was determined for each pairing and a t test to determine statistical significance of the correlation was done. Statistical significance was defined as P value ITE percent correct in PGY I, II and III were 0.46, 0.55 and 0.51 respectively. Corresponding r values for USMLE Step 2 and ITE percent correct were 0.79, 0.70 and 0.72; for USMLE Step 3 these values were 0.51, 0.37 and 0.51 respectively for each training year. USMLE scores are correlated with ITE scores. This correlation was strongest for USMLE Step 2.

  11. Mentorship in orthopaedic and trauma residency training ...

    African Journals Online (AJOL)

    Background: Mentorship is important in residency training as it is necessary for personal and professional development of the resident trainees. Objectives: This study documents mentorship in orthopaedic residency training programme in Nigeria by assessing the awareness of orthopaedic residents on the role of a mentor, ...

  12. Development of a New South Dakota Rural Family Medicine Residency Program.

    Science.gov (United States)

    Heisler, Jean; Huber, Thomas; Huntington, Mark K

    2017-11-01

    The healthcare workforce is a priority in South Dakota. It has been estimated that 8,000 additional healthcare workers beyond those in practice in 2010 will be needed by 2020. In 2016, the South Dakota Department of Health included in its budget funds for the development of a new Rural Family Medicine Residency Training Program as one of the steps toward addressing the physician component of these workforce needs. This new program has just received its accreditation and is recruiting the inaugural class of resident physicians for the spring of 2018. This article provides a concise overview of the program's initial development. Copyright© South Dakota State Medical Association.

  13. Should we Google it? Resource use by internal medicine residents for point-of-care clinical decision making.

    Science.gov (United States)

    Duran-Nelson, Alisa; Gladding, Sophia; Beattie, Jim; Nixon, L James

    2013-06-01

    To determine which resources residents use at the point-of-care (POC) for decision making, the drivers for selection of these resources, and how residents use Google/Google Scholar to answer clinical questions at the POC. In January 2012, 299 residents from three internal medicine residencies were sent an electronic survey regarding resources used for POC decision making. Resource use frequency and factors influencing choice were determined using descriptive statistics. Binary logistic regression analysis was performed to determine relationships between the independent variables. A total of 167 residents (56%) responded; similar numbers responded at each level of training. Residents most frequently reported using UpToDate and Google at the POC at least daily (85% and 63%, respectively), with speed and trust in the quality of information being the primary drivers of selection. Google, used by 68% of residents, was used primarily to locate Web sites and general information about diseases, whereas Google Scholar, used by 30% of residents, tended to be used for treatment and management decisions or locating a journal article. The findings suggest that internal medicine residents use UpToDate most frequently, followed by consultation with faculty and the search engines Google and Google Scholar; speed, trust, and portability are the biggest drivers for resource selection; and time and information overload appear to be the biggest barriers to resources such as Ovid MEDLINE. Residents frequently used Google and may benefit from further training in information management skills.

  14. A national survey of terrorism preparedness training among pediatric, family practice, and emergency medicine programs.

    Science.gov (United States)

    Martin, Shelly D; Bush, Anneke C; Lynch, Julia A

    2006-09-01

    Domestic terrorism is a real threat focusing on a need to engage in effective emergency preparedness planning and training. Front-line physicians are an important component of any emergency preparedness plan. Potential victims of an attack include children who have unique physiologic and psychological vulnerabilities in disasters. Front-line providers need to have adequate training to effectively participate in local planning initiatives and to recognize and treat casualties including children. The goal of the survey was to assess the current state of terrorism preparedness training, including child victims, by emergency medicine, family practice, and pediatric residency programs in the United States and to assess methods of training and barriers to establishing effective training. A survey was e-mailed to a comprehensive list of all US pediatric, family practice, and emergency medicine residency programs 3 times between September 2003 and January 2004. The survey measured the perceived risk of terrorist attack, level of training by type of attack, level of training regarding children, method of training, and barriers to training. Overall, 21% of programs responded (46 of 182 pediatric, 75 of 400 family practice, and 29 of 125 emergency medicine programs). Across all of the event types, emergency medicine programs were more likely to report adequate/comprehensive training. However, terrorism preparedness funding, these data suggest that we are failing to provide adequate training to front-line providers who may care for children in a catastrophic domestic terrorist event.

  15. Important Skills for Internship and the Fourth-Year Medical School Courses to Acquire Them: A National Survey of Internal Medicine Residents.

    Science.gov (United States)

    Pereira, Anne G; Harrell, Heather E; Weissman, Arlene; Smith, Cynthia D; Dupras, Denise; Kane, Gregory C

    2016-06-01

    To obtain feedback from internal medicine residents, a key stakeholder group, regarding both the skills needed for internship and the fourth-year medical school courses that prepared them for residency. This feedback could inform fourth-year curriculum redesign efforts. All internal medicine residents taking the 2013-2014 Internal Medicine In-Training Examination were asked to rank the importance of learning 10 predefined skills prior to internship and to use a dropdown menu of 11 common fourth-year courses to rank the 3 most helpful in preparing for internship. The predefined skills were chosen based on a review of the literature, a national subinternship curriculum, and expert consensus. Chi-square statistics were used to test for differences in responses between training levels. Of the 24,820 internal medicine residents who completed the exam, 20,484 (83%) completed the survey, had complete identification numbers, and consented to have their responses used for research. The three skills most frequently rated as very important were identifying when to seek additional help and expertise, prioritizing clinical tasks and managing time efficiently, and communicating with other providers around care transitions. The subinternship/acting internship was most often selected as being the most helpful course in preparing for internship. These findings indicate which skills and fourth-year medical school courses internal medicine residents found most helpful in preparing for internship and confirm the findings of prior studies highlighting the perceived value of subinternships. Internal medicine residents and medical educators agree on the skills students should learn prior to internship.

  16. Everyday ethics in internal medicine resident clinic: an opportunity to teach.

    Science.gov (United States)

    Carrese, Joseph A; McDonald, Erin L; Moon, Margaret; Taylor, Holly A; Khaira, Kiran; Catherine Beach, Mary; Hughes, Mark T

    2011-07-01

    Being a good doctor requires competency in ethics. Accordingly, ethics education during residency training is important. We studied the everyday ethics-related issues (i.e. ordinary ethics issues commonly faced) that internal medical residents encounter in their out-patient clinic and determined whether teaching about these issues occurred during faculty preceptor-resident interactions. This study involved a multi-method qualitative research design combining observation of preceptor-resident discussions with preceptor interviews. The study was conducted in two different internal medicine training programme clinics over a 2-week period in June 2007. Fifty-three residents and 19 preceptors were observed, and 10 preceptors were interviewed. Transcripts of observer field notes and faculty interviews were carefully analysed. The analysis identified several themes of everyday ethics issues and determined whether preceptors identified and taught about these issues. Everyday ethics content was considered present in 109 (81%) of the 135 observed case presentations. Three major thematic domains and associated sub-themes related to everyday ethics issues were identified, concerning: (i) the Doctor-Patient Interaction (relationships; communication; shared decision making); (ii) the Resident as Learner (developmental issues; challenges and conflicts associated with training; relationships with colleagues and mentors; interactions with the preceptor), and; (iii) the Doctor-System Interaction (financial issues; doctor-system issues; external influences; doctor frustration related to system issues). Everyday ethics issues were explicitly identified by preceptors (without teaching) in 18 of 109 cases (17%); explicit identification and teaching occurred in only 13 cases (12%). In this study a variety of everyday ethics issues were frequently encountered as residents cared for patients. Yet, faculty preceptors infrequently explicitly identified or taught these issues during their

  17. The relationship between internal medicine residency graduate performance on the ABIM certifying examination, yearly in-service training examinations, and the USMLE Step 1 examination.

    Science.gov (United States)

    Kay, Cynthia; Jackson, Jeffrey L; Frank, Michael

    2015-01-01

    To explore the relationship between United States Medical Licensing Examination (USMLE) Step 1 scores, yearly in-service training exam (ITE) scores, and passing the American Board of Internal Medicine certifying examination (ABIM-CE). The authors conducted a retrospective database review of internal medicine residents from the Medical College of Wisconsin from 2004 through 2012. Residents' USMLE Step 1, ITE, and ABIM-CE scores were extracted. Pearson rho, chi-square, and logistic regression were used to determine whether relationships existed between the scores and if Step 1 and ITE scores correlate with passing the ABIM-CE. There were 241 residents, who participated in 728 annual ITEs. There were Step 1 scores for 195 (81%) residents and ABIM-CE scores for 183 (76%). Step 1 and ABIM-CE scores had a modest correlation (rho: 0.59), as did ITE and ABIM-CE scores (rho: 0.48-0.67). Failing Step 1 or being in the bottom ITE quartile during any year of testing markedly increased likelihood of failing the boards (Step 1: relative risk [RR]: 2.4; 95% CI: 1.0-5.9; first-year residents' RR: 1.3; 95% CI: 1.0-1.6; second-year residents' RR: 1.3; 95% CI: 1.1-1.5; third-year residents' RR: 1.3; 95% CI: 1.1-1.5). USMLE Step 1 and ITE scores have a modest correlation with board scores. Failing Step 1 or scoring in the bottom quartile of the ITE increased the risk of failing the boards. What effective intervention, if any, program directors may use with at-risk residents is a question deserving further research.

  18. Does clinical exposure matter? Pilot assessment of patient visits in an urban family medicine residency program.

    Science.gov (United States)

    Iglar, Karl; Murdoch, Stuart; Meaney, Christopher; Krueger, Paul

    2018-01-01

    To determine the number of patient visits, patient demographic information, and diagnoses in an urban ambulatory care setting in a family medicine residency program, and assess the correlation between the number of patient visits and residents' in-training examination (ITE) scores. Retrospective analysis of data from resident practice profiles, electronic medical records, and residents' final ITE scores. Family medicine teaching unit in a community hospital in Barrie, Ont. Practice profile data were from family medicine residents enrolled in the program from July 1, 2013, to June 30, 2014, and electronic medical record and ITE data were from those enrolled in the program from July 1, 2010, to June 30, 2015. Number of patient visits, patient characteristics (eg, sex, age), priority topics addressed in clinic, resident characteristics (eg, age, sex, level of residency), and residents' final ITE scores. Between July 1, 2013, and June 30, 2014, there were 11 115 patient visits. First-year residents had a mean of 5.48 patient visits per clinic, and second-year residents had a mean of 5.98 patient visits per clinic. A Pearson correlation coefficient of 0.68 was found to exist between the number of patients seen and the final ITE scores, with a 10.5% difference in mean score between residents who had 1251 or more visits and those who had 1150 or fewer visits. Three diagnoses (ie, epistaxis, meningitis, and neck pain) deemed important for Certification by the College of Family Physicians of Canada were not seen by any of the residents in clinic. There is a moderate correlation between the number of patients seen by residents in ambulatory care and ITE scores in family medicine. It is important to assess patients' demographic information and diagnoses made in resident practices to ensure an adequate clinical experience. Copyright© the College of Family Physicians of Canada.

  19. Leadership for All: An Internal Medicine Residency Leadership Development Program.

    Science.gov (United States)

    Moore, Jared M; Wininger, David A; Martin, Bryan

    2016-10-01

    Developing effective leadership skills in physicians is critical for safe patient care. Few residency-based models of leadership training exist. We evaluated residents' readiness to engage in leadership training, feasibility of implementing training for all residents, and residents' acceptance of training. In its fourth year, the Leadership Development Program (LDP) consists of twelve 90-minute modules (eg, Team Decision Making and Bias, Leadership Styles, Authentic Leadership) targeting all categorical postgraduate year (PGY) 1 residents. Modules are taught during regularly scheduled educational time. Focus group surveys and discussions, as well as annual surveys of PGY-1s assessed residents' readiness to engage in training. LDP feasibility was assessed by considering sustainability of program structures and faculty retention, and resident acceptance of training was assessed by measuring attendance, with the attendance goal of 8 of 12 modules. Residents thought leadership training would be valuable if content remained applicable to daily work, and PGY-1 residents expressed high levels of interest in training. The LDP is part of the core educational programming for PGY-1 residents. Except for 2 modules, faculty presenters have remained consistent. During academic year 2014-2015, 45% (13 of 29) of categorical residents participated in at least 8 of 12 modules, and 72% (21 of 29) participated in at least 7 of 12. To date, 125 categorical residents have participated in training. Residents appeared ready to engage in leadership training, and the LDP was feasible to implement. The attendance goal was not met, but attendance was sufficient to justify program continuation.

  20. An instrument to characterize the environment for residents' evidence-based medicine learning and practice.

    Science.gov (United States)

    Mi, Misa; Moseley, James L; Green, Michael L

    2012-02-01

    Many residency programs offer training in evidence-based medicine (EBM). However, these curricula often fail to achieve optimal learning outcomes, perhaps because they neglect various contextual factors in the learning environment. We developed and validated an instrument to characterize the environment for EBM learning and practice in residency programs. An EBM Environment Scale was developed following scale development principles. A survey was administered to residents across six programs in primary care specialties at four medical centers. Internal consistency reliability was analyzed with Cronbach's coefficient alpha. Validity was assessed by comparing predetermined subscales with the survey's internal structure as assessed via factor analysis. Scores were also compared for subgroups based on residency program affiliation and residency characteristics. Out of 262 eligible residents, 124 completed the survey (response rate 47%). The overall mean score was 3.89 (standard deviation=0.56). The initial reliability analysis of the 48-item scale had a high reliability coefficient (Cronbach α=.94). Factor analysis and further item analysis resulted in a shorter 36-item scale with a satisfactory reliability coefficient (Cronbach α=.86). Scores were higher for residents with prior EBM training in medical school (4.14 versus 3.62) and in residency (4.25 versus 3.69). If further testing confirms its properties, the EBM Environment Scale may be used to understand the influence of the learning environment on the effectiveness of EBM training. Additionally, it may detect changes in the EBM learning environment in response to programmatic or institutional interventions.

  1. Are Simulation Stethoscopes a Useful Adjunct for Emergency Residents' Training on High-Fidelity Mannequins?

    Directory of Open Access Journals (Sweden)

    Steven J Warrington

    2013-05-01

    Full Text Available Introduction: Emergency medicine residents use simulation training for many reasons, such as gaining experience with critically ill patients and becoming familiar with disease processes. Residents frequently criticize simulation training using current high-fidelity mannequins due to the poor quality of physical exam findings present, such as auscultatory findings, as it may lead them down an alternate diagnostic or therapeutic pathway. Recently wireless remote programmed stethoscopes (simulation stethoscopes have been developed that allow wireless transmission of any sound to a stethoscope receiver, which improves the fidelity of a physical examination and the simulation case. Methods: Following institutional review committee approval, 14 PGY1-3 emergency medicine residents were assessed during 2 simulation-based cases using pre-defined scoring anchors on multiple actions, such as communication skills and treatment decisions (Appendix 1. Each case involved a patient presenting with dyspnea requiring management based off physical examination findings. One case was a patient with exacerbation of heart failure, while the other was a patient with a tension pneumothorax. Each resident was randomized into a case associated with the simulation stethoscope. Following the cases residents were asked to fill out an evaluation questionnaire. Results: Residents perceived the most realistic physical exam findings on those associated with the case using the simulation stethoscope (13/14, 93%. Residents also preferred the simulation stethoscope as an adjunct to the case (13/14, 93%, and they rated the simulation stethoscope case to have significantly more realistic auscultatory findings (4.4/5 vs. 3.0/5 difference of means 1.4, P = 0.0007. Average scores of residents were significantly better in the simulation stethoscope-associated case (2.5/3 vs. 2.3/3 difference of means 0.2, P = 0.04. There was no considerable difference in the total time taken per case

  2. Canadian residents' perceived manager training needs.

    Science.gov (United States)

    Stergiopoulos, Vicky; Lieff, Susan; Razack, Saleem; Lee, A Curtis; Maniate, Jerry M; Hyde, Stacey; Taber, Sarah; Frank, Jason R

    2010-01-01

    Despite widespread endorsement for administrative training during residency, teaching and learning in this area remains intermittent and limited in most programmes. To inform the development of a Manager Train-the-Trainer program for faculty, the Royal College of Physicians and Surgeons of Canada undertook a survey of perceived Manager training needs among postgraduate trainees. A representative sample of Canadian specialty residents received a web-based questionnaire in 2009 assessing their perceived deficiencies in 13 Manager knowledge and 11 Manager skill domains, as determined by gap scores (GSs). GSs were defined as the difference between residents' perceived current and desired level of knowledge or skill in selected Manager domains. Residents' educational preferences for furthering their Manager knowledge and skills were also elicited. Among the 549 residents who were emailed the survey, 199 (36.2%) responded. Residents reported significant gaps in most knowledge and skills domains examined. Residents' preferred educational methods for learning Manager knowledge and skills included workshops, web-based formats and interactive small groups. The results of this national survey, highlighting significant perceived gaps in multiple Manager knowledge and skills domains, may inform the development of Manager curricula and faculty development activities to address deficiencies in training in this important area.

  3. Integrating motivational interviewing and narrative therapy to teach behavior change to family medicine resident physicians.

    Science.gov (United States)

    Oshman, Lauren D; Combs, Gene N

    2016-05-01

    Motivational interviewing is a useful skill to address the common problem of patient ambivalence regarding behavior change by uncovering and strengthening a person's own motivation and commitment to change. The Family Medicine Milestones underline the need for clear teaching and monitoring of skills in communication and behavior change in Family Medicine postgraduate training settings. This article reports the integration of a motivational interviewing curriculum into an existing longitudinal narrative therapy-based curriculum on patient-centered communication. Observed structured clinical examination for six participants indicate that intern physicians are able to demonstrate moderate motivational interviewing skill after a brief 2-h workshop. Participant self-evaluations for 16 participants suggest a brief 2-h curriculum was helpful at increasing importance of learning motivational interviewing by participants, and that participants desire further training opportunities. A brief motivational interviewing curriculum can be integrated into existing communication training in a Family Medicine residency training program. © The Author(s) 2016.

  4. Using Precept-Assist® to predict performance on the American Board of Family Medicine In-Training Examination.

    Science.gov (United States)

    Post, Robert E; Jamena, Gemma P; Gamble, James D

    2014-09-01

    Precept-Assist® (PA) is a computer-based program developed by the Virtua Family Medicine Residency where residents receive a score on a Likert-type scale from an attending for each precept based on their knowledge base. The purpose of this study was to attempt to validate this program for precepting family medicine residents. This was a validation study. PA and American Board of Family Medicine (ABFM) In-Training Exam (ITE) scores for all residents from a community-based family medicine residency between the years 2002 and 2011 were included (n=216). Pearson correlation coefficients were calculated between PA scores for the second quarter of the academic year (October 1 to December 31) and scores on the ITE. An ROC curve was also created to determine sensitivity and specificity for various PA scores in predicting residents scoring 500 or above on the ITE. The PA mean (SD) score was 5.18 (0.84) and the ITE mean (SD) score was 425.1 (87.6). The Pearson correlation coefficient between PA and ITE scores was 0.55, which is a moderately positive correlation. The AUC of the ROC curve was 0.783 (95% CI 0.704-0.859). A PA score of 5.5 (between the level of a PGY-2 and PGY-3) was 72% sensitive and 77% specific for scoring 500 or above on the ITE with a positive LR of 3.12. There is a significant correlation between PA scores and ABFM In-Training Exam scores. PA is a valid screening tool that can be used as a predictor for future performance in Family Medicine In-Training exams.

  5. Teaching Humanities in Medicine: The University of Massachusetts Family Medicine Residency Program Experience

    Science.gov (United States)

    Silk, Hugh; Shields, Sara

    2012-01-01

    Humanities in medicine (HIM) is an important aspect of medical education intended to help preserve humanism and a focus on patients. At the University of Massachusetts Family Medicine Residency Program, we have been expanding our HIM curriculum for our residents including orientation, home visit reflective writing, didactics and a department-wide…

  6. The U.S. Army Occupational and Environmental Medicine Residency at Aberdeen Proving Ground, Maryland: 1960-1996.

    Science.gov (United States)

    Gaydos, Joel C; Mallon, Timothy M; Rice, William A

    2016-11-01

    Reorganization of the Army and critical assessment of Army Graduate Medical Education programs prompted the Occupational and Environmental Medicine (OEM) Consultant to the Army Surgeon General to initiate a review of current Army OEM residency training. Available information indicated the Army OEM residency at Aberdeen Proving Ground, MD, was the first and longest operating Army OEM residency. Describing this residency was identified as the first step in the review, with the objectives of determining why the residency was started and sustained and its relevance to the needs of the Army. Records possibly related to the residency were reviewed, starting with 1954 since certification of physicians as Occupation Medicine specialists began in 1955. Interviews were conducted with selected physicians who had strong affiliations with the Army residency and the practice of Army OEM. The Army OEM residency began in 1960 and closed in 1996 with the transfer of Army OEM residency training to the Uniformed Services University of the Health Sciences, Bethesda, MD. Over 36 years, 47 uniformed residency graduates were identified; 44 were from the Army. Forty graduated between 1982 and 1996. The OEM residency was part of a dynamic cycle. Uniformed OEM leaders identified the knowledge and skills required of military OEM physicians and where these people should be stationed in the global Army. Rotations at military sites to acquire the needed knowledge and skills were integrated into the residency. Residency graduates were assigned to positions where they were needed. Having uniformed residents and preceptors facilitated the development of trust with military leaders and access to areas where OEM physician skills and knowledge could have a positive impact. Early reports indicated the residency was important in recruiting and retaining OEM physicians, with emphasis placed on supporting the Army industrial base. The late 1970s into the 1990s was a more dynamic period. There was

  7. Changes in medicine: residency

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2011-07-01

    Full Text Available No abstract available. Article truncated at 150 words. The most important time in a physician’s educational development is residency, especially the first year. However, residency work and responsibility have come under the scrutiny of a host of agencies and bureaucracies, and therefore, is rapidly changing. Most important in the alphabet soup of regulatory agencies is the Accreditation Council for Graduate Medical Education (ACGME which accredits residencies and ultimately makes the governing rules.Resident work hours have received much attention and are clearly decreasing. However, the decline in work hours began in the 1970’s before the present political push to decrease work hours. The residency I entered in 1976 had every third night call during the first year resident’s 6-9 months on general medicine or wards. It had changed from every other night the year before. On wards, we normally were in the hospital for our 24 hours of call and followed this with a 10-12 hour day before …

  8. Pass rates on the American Board of Family Medicine Certification Exam by residency location and size.

    Science.gov (United States)

    Falcone, John L; Middleton, Donald B

    2013-01-01

    The Accreditation Council for Graduate Medical Education (ACGME) sets residency performance standards for the American Board of Family Medicine Certification Examination. This study aims are to describe the compliance of residency programs with ACGME standards and to determine whether residency pass rates depend on program size and location. In this retrospective cohort study, residency performance from 2007 to 2011 was compared with the ACGME performance standards. Simple linear regression was performed to see whether program pass rates were dependent on program size. Regional differences in performance were compared with χ(2) tests, using an α level of 0.05. Of 429 total residency programs, there were 205 (47.8%) that violate ACGME performance standards. Linear regression showed that program pass rates were positively correlated and dependent on program size (P family medicine training programs do not meet the ACGME examination performance standards. Pass rates are associated with residency program size, and regional variation occurs. These findings have the potential to affect ACGME policy and residency program application patterns.

  9. 'So you want to be a clinician-educator...': designing a clinician-educator curriculum for internal medicine residents.

    Science.gov (United States)

    Heflin, Mitchell T; Pinheiro, Sandro; Kaminetzky, Catherine P; McNeill, Diana

    2009-06-01

    Despite a growing demand for skilled teachers and administrators in graduate medical education, clinician-educator tracks for residents are rare and though some institutions offer 'resident-as-teacher' programs to assist residents in developing teaching skills, the need exists to expand training opportunities in this area. The authors conducted a workshop at a national meeting to develop a description of essential components of a training pathway for internal medicine residents. Through open discussion and small group work, participants defined the various roles of clinician-educators and described goals, training opportunities, assessment and resource needs for such a program. Workshop participants posited that the clinician-educator has several roles to fulfill beyond that of clinician, including those of teacher, curriculum developer, administrator and scholar. A pathway for residents aspiring to become clinician educators must offer structured training in each of these four areas to empower residents to effectively practice clinical education. In addition, the creation of such a track requires securing time and resources to support resident learning experiences and formal faculty development programs to support institutional mentors and leaders. This article provides a framework by which leaders in medical education can begin to prepare current trainees interested in careers as clinician-educators.

  10. The effect on reliability and sensitivity to level of training of combining analytic and holistic rating scales for assessing communication skills in an internal medicine resident OSCE.

    Science.gov (United States)

    Daniels, Vijay John; Harley, Dwight

    2017-07-01

    Although previous research has compared checklists to rating scales for assessing communication, the purpose of this study was to compare the effect on reliability and sensitivity to level of training of an analytic, a holistic, and a combined analytic-holistic rating scale in assessing communication skills. The University of Alberta Internal Medicine Residency runs OSCEs for postgraduate year (PGY) 1 and 2 residents and another for PGY-4 residents. Communication stations were scored with an analytic scale (empathy, non-verbal skills, verbal skills, and coherence subscales) and a holistic scale. Authors analyzed reliability of individual and combined scales using generalizability theory and evaluated each scale's sensitivity to level of training. For analytic, holistic, and combined scales, 12, 12, and 11 stations respectively yielded a Phi of 0.8 for the PGY-1,2 cohort, and 16, 16, and 14 stations yielded a Phi of 0.8 for the PGY-4 cohort. PGY-4 residents scored higher on the combined scale, the analytic rating scale, and the non-verbal and coherence subscales. A combined analytic-holistic rating scale increased score reliability and was sensitive to level of training. Given increased validity evidence, OSCE developers should consider combining analytic and holistic scales when assessing communication skills. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Training the next generation of providers in addiction medicine.

    Science.gov (United States)

    Rasyidi, Ernest; Wilkins, Jeffery N; Danovitch, Itai

    2012-06-01

    Within the United States there exists a profound discrepancy between the significant public health problem of substance abuse and the access to treatment for addicted individuals. Part of the insufficient access to treatment is a function of relatively low levels or professional experts in addiction medicine. Part of the low levels of professional addiction experts is the result of inadequate addiction medicine training of medical students and residents. This article outlines deficits in addiction medicine training among medical students and residents, yet real change in the addiction medicine training process will always be subject to the complexity of producing alterations across multiple credentialing institutions as well as the keen competition between educators for “more time” for their particular subject. Other hurdles include the broad-based issue of stigma regarding alcoholism and other substance abuse that likely impact all systems that regulate physician addiction medicine training. As noted in the discussion of psychiatry residency, even psychiatry residents manifest stigma regarding substance abusing patients. Five currently active processes may allow for fundamental change to the inertia in physician addiction medicine training while also potentially impacting stigma: 1. We appear to be at the beginning of the integration of addiction into traditional medicine through the formation of a legitimized addiction medicine subspecialty. 2. The training of primary care trainees and practitioners in the use of SBIRT is accelerating, thus creating another process of addiction integration into traditional medicine. 3. The PCMH is being established as a model for primary care 4. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) became effective for group health care plan years beginning on or after July 1, 2010; thereby, substance abuse benefits and cost are to be the same as general medical or surgical

  12. Emergency ultrasound usage among recent emergency medicine residency graduates of a convenience sample of 14 residencies.

    Science.gov (United States)

    Dean, Anthony J; Breyer, Michael J; Ku, Bon S; Mills, Angela M; Pines, Jesse M

    2010-02-01

    Emergency Medicine (EM) residency graduates are trained to perform Emergency Medicine bedside ultrasound (EMBU). However, the degree to which they use this skill in their practice after graduation is unknown. We sought to test the amount and type of usage of EMBU among recent residency graduates, and how usage and barriers vary among various types of EM practice settings. Graduates from 14 EM residency programs in 2003-2005 were surveyed on their current practice setting and use of EMBU. There were 252 (73%) graduates who completed the survey. Of the 73% of respondents reporting access to EMBU, 98% had used it within the past 3 months. Access to EMBU was higher in academic (97%) vs. community teaching (79%) vs. community non-teaching settings (62%) (p < 0.001), and in Emergency Departments (EDs) where yearly census exceeded 60,000 visits (87% vs. 65%, p < 0.001). Physicians in academic settings reported "high use" of EMBU more frequently than those in community settings for most modalities. FAST (focused assessment by sonography in trauma) was the most common high-use application and the most useful in practice. The greatest impediment to EMBU use was "not enough time" (61%). Ultrasound usage among recent EM residency graduates is significantly higher in teaching than in community settings and in high-volume EDs. Its use is more widespread than in previous reports in all types of practice. There is a wide range of utilization of ultrasound in the various applications in emergency practice, with the evaluation of trauma being the most common. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  13. Communication About Advance Directives and End-of-Life Care Options Among Internal Medicine Residents

    Science.gov (United States)

    Rhodes, Ramona L.; Tindall, Kate; Xuan, Lei; Paulk, M. Elizabeth; Halm, Ethan A.

    2015-01-01

    Background Despite increasing awareness about the importance of discussing end-of-life (EOL) care options with terminally ill patients and families, many physicians remain uncomfortable with these discussions. Objective The objective of the study was to examine perceptions of and comfort with EOL care discussions among a group of internal medicine residents and the extent to which comfort with these discussions has improved over time. Methods In 2013, internal medicine residents at a large academic medical center were asked to participate in an on-line survey that assessed their attitudes and experiences with discussing EOL care with terminally-ill patients. These results were compared to data from a similar survey residents in the same program completed in 2006. Results Eighty-three (50%) residents completed the 2013 survey. About half (52%) felt strongly that they were able to have open, honest discussions with patients and families, while 71% felt conflicted about whether CPR was in the patient’s best interest. About half (53%) felt strongly that it was okay for them to tell a patient/family member whether or not CPR was a good idea for them. Compared to 2006 respondents, the 2013 cohort felt they had more lectures about EOL communication, and had watched an attending have an EOL discussion more often. Conclusions Modest improvements were made over time in trainees’ exposure to EOL discussions; however, many residents remain uncomfortable and conflicted with having EOL care discussions with their patients. More effective training approaches in EOL communication are needed to train the next generation of internists. PMID:24418692

  14. Communication About Advance Directives and End-of-Life Care Options Among Internal Medicine Residents.

    Science.gov (United States)

    Rhodes, Ramona L; Tindall, Kate; Xuan, Lei; Paulk, M Elizabeth; Halm, Ethan A

    2015-05-01

    Despite increasing awareness about the importance of discussing end-of-life (EOL) care options with terminally ill patients and families, many physicians remain uncomfortable with these discussions. The objective of the study was to examine perceptions of and comfort with EOL care discussions among a group of internal medicine residents and the extent to which comfort with these discussions has improved over time. In 2013, internal medicine residents at a large academic medical center were asked to participate in an on-line survey that assessed their attitudes and experiences with discussing EOL care with terminally-ill patients. These results were compared to data from a similar survey residents in the same program completed in 2006. Eighty-three (50%) residents completed the 2013 survey. About half (52%) felt strongly that they were able to have open, honest discussions with patients and families, while 71% felt conflicted about whether CPR was in the patient's best interest. About half (53%) felt strongly that it was okay for them to tell a patient/family member whether or not CPR was a good idea for them. Compared to 2006 respondents, the 2013 cohort felt they had more lectures about EOL communication, and had watched an attending have an EOL discussion more often. Modest improvements were made over time in trainees' exposure to EOL discussions; however, many residents remain uncomfortable and conflicted with having EOL care discussions with their patients. More effective training approaches in EOL communication are needed to train the next generation of internists. © The Author(s) 2014.

  15. Simulation in Canadian postgraduate emergency medicine training - a national survey.

    Science.gov (United States)

    Russell, Evan; Hall, Andrew Koch; Hagel, Carly; Petrosoniak, Andrew; Dagnone, Jeffrey Damon; Howes, Daniel

    2018-01-01

    Simulation-based education (SBE) is an important training strategy in emergency medicine (EM) postgraduate programs. This study sought to characterize the use of simulation in FRCPC-EM residency programs across Canada. A national survey was administered to residents and knowledgeable program representatives (PRs) at all Canadian FRCPC-EM programs. Survey question themes included simulation program characteristics, the frequency of resident participation, the location and administration of SBE, institutional barriers, interprofessional involvement, content, assessment strategies, and attitudes about SBE. Resident and PR response rates were 63% (203/321) and 100% (16/16), respectively. Residents reported a median of 20 (range 0-150) hours of annual simulation training, with 52% of residents indicating that the time dedicated to simulation training met their needs. PRs reported the frequency of SBE sessions ranging from weekly to every 6 months, with 15 (94%) programs having an established simulation curriculum. Two (13%) of the programs used simulation for resident assessment, although 15 (94%) of PRs indicated that they would be comfortable with simulation-based assessment. The most common PR-identified barriers to administering simulation were a lack of protected faculty time (75%) and a lack of faculty experience with simulation (56%). Interprofessional involvement in simulation was strongly valued by both residents and PRs. SBE is frequently used by Canadian FRCPC-EM residency programs. However, there exists considerable variability in the structure, frequency, and timing of simulation-based activities. As programs transition to competency-based medical education, national organizations and collaborations should consider the variability in how SBE is administered.

  16. Learning Through Experience: Influence of Formal and Informal Training on Medical Error Disclosure Skills in Residents.

    Science.gov (United States)

    Wong, Brian M; Coffey, Maitreya; Nousiainen, Markku T; Brydges, Ryan; McDonald-Blumer, Heather; Atkinson, Adelle; Levinson, Wendy; Stroud, Lynfa

    2017-02-01

    Residents' attitudes toward error disclosure have improved over time. It is unclear whether this has been accompanied by improvements in disclosure skills. To measure the disclosure skills of internal medicine (IM), paediatrics, and orthopaedic surgery residents, and to explore resident perceptions of formal versus informal training in preparing them for disclosure in real-world practice. We assessed residents' error disclosure skills using a structured role play with a standardized patient in 2012-2013. We compared disclosure skills across programs using analysis of variance. We conducted a multiple linear regression, including data from a historical cohort of IM residents from 2005, to investigate the influence of predictor variables on performance: training program, cohort year, and prior disclosure training and experience. We conducted a qualitative descriptive analysis of data from semistructured interviews with residents to explore resident perceptions of formal versus informal disclosure training. In a comparison of disclosure skills for 49 residents, there was no difference in overall performance across specialties (4.1 to 4.4 of 5, P  = .19). In regression analysis, only the current cohort was significantly associated with skill: current residents performed better than a historical cohort of 42 IM residents ( P  formal (workshops, morbidity and mortality rounds) and informal (role modeling, debriefing) activities in preparation for disclosure in real-world practice. Residents across specialties have similar skills in disclosure of errors. Residents identified role modeling and a strong local patient safety culture as key facilitators for disclosure.

  17. Emergency Medicine Resident Perceptions of Medical Professionalism

    Directory of Open Access Journals (Sweden)

    Joshua Jauregui

    2016-05-01

    Full Text Available Introduction: Medical professionalism is a core competency for emergency medicine (EM trainees; but defining professionalism remains challenging, leading to difficulties creating objectives and performing assessment. Because professionalism is dynamic, culture-specific, and often taught by modeling, an exploration of trainees’ perceptions can highlight their educational baseline and elucidate the importance they place on general conventional professionalism domains. To this end, our objective was to assess the relative value EM residents place on traditional components of professionalism. Methods: We performed a cross-sectional, multi-institutional survey of incoming and graduating EM residents at four programs. The survey was developed using the American Board of Internal Medicine’s “Project Professionalism” and the Accreditation Council of Graduate Medical Education definition of professionalism competency. We identified 27 attributes within seven domains: clinical excellence, humanism, accountability, altruism, duty and service, honor and integrity, and respect for others. Residents were asked to rate each attribute on a 10-point scale. We analyzed data to assess variance across attributes as well as differences between residents at different training levels or different institutions. Results: Of the 114 residents eligible, 100 (88% completed the survey. The relative value assigned to different professional attributes varied considerably, with those in the altruism domain valued significantly lower and those in the “respect for others” and “honor and integrity” valued significantly higher (p<0.001. Significant differences were found between interns and seniors for five attributes primarily in the “duty and service” domain (p<0.05. Among different residencies, significant differences were found with attributes within the “altruism” and “duty and service” domains (p<0.05. Conclusion: Residents perceive differences in

  18. Well-being in residency training: a survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta

    Directory of Open Access Journals (Sweden)

    Patten Scott

    2005-06-01

    Full Text Available Abstract Background Despite the critical importance of well-being during residency training, only a few Canadian studies have examined stress in residency and none have examined well-being resources. No recent studies have reported any significant concerns with respect to perceived stress levels in residency. We investigated the level of perceived stress, mental health and understanding and need for well-being resources among resident physicians in training programs in Alberta, Canada. Methods A mail questionnaire was distributed to the entire resident membership of PARA during 2003 academic year. PARA represents each of the two medical schools in the province of Alberta. Results In total 415 (51 % residents participated in the study. Thirty-four percent of residents who responded to the survey reported their life as being stressful. Females reported stress more frequently than males (40% vs. 27%, p Residents highly valued their colleagues (67%, program directors (60% and external psychiatrist/psychologist (49% as well-being resources. Over one third of residents wished to have a career counselor (39% and financial counselor (38%. Conclusion Many Albertan residents experience significant stressors and emotional and mental health problems. Some of which differ among genders. This study can serve as a basis for future resource application, research and advocacy for overall improvements to well-being during residency training.

  19. Training the next generation of physician-executives: an innovative residency pathway in management and leadership.

    Science.gov (United States)

    Ackerly, D Clay; Sangvai, Devdutta G; Udayakumar, Krishna; Shah, Bimal R; Kalman, Noah S; Cho, Alex H; Schulman, Kevin A; Fulkerson, William J; Dzau, Victor J

    2011-05-01

    The rapidly changing field of medicine demands that future physician-leaders excel not only in clinical medicine but also in the management of complex health care enterprises. However, many physicians have become leaders "by accident," and the active cultivation of future leaders is required. Addressing this need will require multiple approaches, targeting trainees at various stages of their careers, such as degree-granting programs, residency and fellowship training, and career and leadership development programs. Here, the authors describe a first-of-its-kind graduate medical education pathway at Duke Medicine, the Management and Leadership Pathway for Residents (MLPR). This program was developed for residents with both a medical degree and management training. Created in 2009, with its first cohort enrolled in the summer of 2010, the MLPR is intended to help catalyze the emergence of a new generation of physician-leaders. The program will provide physicians-in-training with rigorous clinical exposure along with mentorship and rotational opportunities in management to accelerate the development of critical leadership and management skills in all facets of medicine, including care delivery, research, and education. To achieve this, the MLPR includes 15 to 18 months of project-based rotations under the guidance of senior leaders in many disciplines including finance, patient safety, health system operations, strategy, and others. Developing both clinical and management skill sets during graduate medical education holds the promise of engaging future leaders of health care at an early career stage, keeping more MD-MBA graduates within health care, and creating a bench of talented future physician-executives. Copyright © by the Association of American medical Colleges.

  20. Assessing the Effects of the 2003 Resident Duty Hours Reform on Internal Medicine Board Scores

    Science.gov (United States)

    Romano, Patrick S.; Itani, Kamal M.F.; Rosen, Amy K.; Small, Dylan; Lipner, Rebecca S.; Bosk, Charles L.; Wang, Yanli; Halenar, Michael J.; Korovaichuk, Sophia; Even-Shoshan, Orit; Volpp, Kevin G.

    2014-01-01

    Purpose To determine whether the 2003 Accreditation Council for Graduate Medical Education (ACGME) duty hours reform affected medical knowledge as reflected by written board scores for internal medicine (IM) residents. Method The authors conducted a retrospective cohort analysis of postgraduate year 1 (PGY-1) Internal Medicine residents who started training before and after the 2003 duty hour reform using a merged data set of American Board of Internal Medicine (ABIM) Board examination and the National Board of Medical Examiners (NMBE) United States Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge test scores. Specifically, using four regression models, the authors compared IM residents beginning PGY-1 training in 2000 and completing training unexposed to the 2003 duty hours reform (PGY-1 2000 cohort, n = 5,475) to PGY-1 cohorts starting in 2001 through 2005 (n = 28,008), all with some exposure to the reform. Results The mean ABIM board score for the unexposed PGY-1 2000 cohort (n = 5,475) was 491, SD = 85. Adjusting for demographics, program, and USMLE Step 2 exam score, the mean differences (95% CI) in ABIM board scores between the PGY-1 2001, 2002, 2003, 2004 and 2005 cohorts minus the PGY-1 2000 cohort were −5.43 (−7.63, −3.23), −3.44 (−5.65, −1.24), 2.58 (0.36, 4.79), 11.10 (8.88, 13.33) and 11.28 (8.98, 13.58) points respectively. None of these differences exceeded one-fifth of an SD in ABIM board scores. Conclusions The duty hours reforms of 2003 did not meaningfully affect medical knowledge as measured by scores on the ABIM board examinations. PMID:24556772

  1. Residents' Perspectives on Careers in Academic Medicine: Obstacles and Opportunities.

    Science.gov (United States)

    Lin, Steven; Nguyen, Cathina; Walters, Emily; Gordon, Paul

    2018-03-01

    Worsening faculty shortages in medical schools and residency programs are threatening the US medical education infrastructure. Little is known about the factors that influence the decision of family medicine residents to choose or not choose academic careers. Our study objective was to answer the following question among family medicine residents: "What is your greatest concern or fear about pursuing a career in academic family medicine?" Participants were family medicine residents who attended the Faculty for Tomorrow Workshop at the Society of Teachers of Family Medicine Annual Spring Conference in 2016 and 2017. Free responses to the aforementioned prompt were analyzed using a constant comparative method and grounded theory approach. A total of 156 participants registered for the workshops and 95 (61%) answered the free response question. Eight distinct themes emerged from the analysis. The most frequently recurring theme was "lack of readiness or mentorship," which accounted for nearly one-third (31%) of the codes. Other themes included work-life balance and burnout (17%), job availability and logistics (15%), lack of autonomy or flexibility (11%), competing pressures/roles (10%), lower financial rewards (4%), politics and bureaucracy (4%), and research (3%). To our knowledge, this is the first study to identify barriers and disincentives to pursuing a career in academic medicine from the perspective of family medicine residents. There may be at least eight major obstacles, for which we summarize and consider potential interventions. More research is needed to understand why residents choose, or don't choose, academic careers.

  2. Development of geriatric competencies for emergency medicine residents using an expert consensus process.

    Science.gov (United States)

    Hogan, Teresita M; Losman, Eve D; Carpenter, Christopher R; Sauvigne, Karen; Irmiter, Cheryl; Emanuel, Linda; Leipzig, Rosanne M

    2010-03-01

    The emergency department (ED) visit rate for older patients exceeds that of all age groups other than infants. The aging population will increase elder ED patient utilization to 35% to 60% of all visits. Older patients can have complex clinical presentations and be resource-intensive. Evidence indicates that emergency physicians fail to provide consistent high-quality care for elder ED patients, resulting in poor clinical outcomes. The objective was to develop a consensus document, "Geriatric Competencies for Emergency Medicine Residents," by identified experts. This is a minimum set of behaviorally based performance standards that all residents should be able to demonstrate by completion of their residency training. This consensus-based process utilized an inductive, qualitative, multiphase method to determine the minimum geriatric competencies needed by emergency medicine (EM) residents. Assessments of face validity and reliability were used throughout the project. In Phase I, participants (n=363) identified 12 domains and 300 potential competencies. In Phase II, an expert panel (n=24) clustered the Phase I responses, resulting in eight domains and 72 competencies. In Phase III, the expert panel reduced the competencies to 26. In Phase IV, analysis of face validity and reliability yielded a 100% consensus for eight domains and 26 competencies. The domains identified were atypical presentation of disease; trauma, including falls; cognitive and behavioral disorders; emergent intervention modifications; medication management; transitions of care; pain management and palliative care; and effect of comorbid conditions. The Geriatric Competencies for EM Residents is a consensus document that can form the basis for EM residency curricula and assessment to meet the demands of our aging population. Copyright (c) 2010 by the Society for Academic Emergency Medicine.

  3. Competencies "plus": the nature of written comments on internal medicine residents' evaluation forms.

    Science.gov (United States)

    Ginsburg, Shiphra; Gold, Wayne; Cavalcanti, Rodrigo B; Kurabi, Bochra; McDonald-Blumer, Heather

    2011-10-01

    Comments on residents' in-training evaluation reports (ITERs) may be more useful than scores in identifying trainees in difficulty. However, little is known about the nature of comments written by internal medicine faculty on residents' ITERs. Comments on 1,770 ITERs (from 180 residents in postgraduate years 1-3) were analyzed using constructivist grounded theory beginning with an existing framework. Ninety-three percent of ITERs contained comments, which were frequently easy to map onto traditional competencies, such as knowledge base (n = 1,075 comments) to the CanMEDs Medical Expert role. Many comments, however, could be linked to several overlapping competencies. Also common were comments completely unrelated to competencies, for instance, the resident's impact on staff (813), or personality issues (450). Residents' "trajectory" was a major theme (performance in relation to expected norms [494], improvement seen [286], or future predictions [286]). Faculty's assessments of residents are underpinned by factors related and unrelated to traditional competencies. Future evaluations should attempt to capture these holistic, integrated impressions.

  4. Implementing the 2009 Institute of Medicine recommendations on resident physician work hours, supervision, and safety

    Directory of Open Access Journals (Sweden)

    Blum AB

    2011-06-01

    Full Text Available Alexander B Blum1, Sandra Shea2, Charles A Czeisler3,4, Christopher P Landrigan3-5, Lucian Leape61Department of Health and Evidence Policy, Mount Sinai School of Medicine, New York, NY, USA; 2Committee of Interns and Residents, SEIU Healthcare Division, Service Employees International Union, New York, NY, USA; 3Harvard Work Hours, Health and Safety Group, Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA; 4Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; 5Division of General Pediatrics, Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA; 6Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USAAbstract: Long working hours and sleep deprivation have been a facet of physician training in the US since the advent of the modern residency system. However, the scientific evidence linking fatigue with deficits in human performance, accidents and errors in industries from aeronautics to medicine, nuclear power, and transportation has mounted over the last 40 years. This evidence has also spawned regulations to help ensure public safety across safety-sensitive industries, with the notable exception of medicine.

  5. Why Do Emergency Medicine Residents Experience Burn Out? A qualitative study

    Directory of Open Access Journals (Sweden)

    Atefe Kamaloo

    2017-06-01

    Full Text Available Objective: Emergency medicine residents are a high–risk group for burnout syndrome. This was a qualitative study with content analysis on emergency medical residents with 2 aims: evaluating the incidence of occupational burnout syndrome and identifying the points of view and attitudes of emergency medical residents about factors related to occupational burnout syndrome.Method: For this study, 2 sessions of focus group discussions were set up at Imam Khomeini hospital affiliated to Tehran University of Medical Sciences. Each session took 90 minutes, and 20 emergency medicine residents in their first or second year of emergency medicine residency participated in the sessions. Data were coded   by MAXQDA10 software.Results: Data were categorized in 4 themes as follow: (1 the characteristics of emergency medicine; (2 ambiguity in residents’ duties; (3 educational planning; and (4 careers.Data on the proposed solutions by residents were analyzed and coded in 3 groups including (1 changes in personal life; (2 arrangement in shifts; and  (3 educational issues.Conclusion: According to findings of this qualitative study, most of emergency medicine residents have experienced exhaustion sometime during the course of their residency. Psychological supports may help the residents to cope with their career difficulties and probable burn out.

  6. An Update of Oral Health Curricula in US Family Medicine Residency Programs.

    Science.gov (United States)

    Silk, Hugh; Savageau, Judith A; Sullivan, Kate; Sawosik, Gail; Wang, Min

    2018-06-01

    National initiatives have encouraged oral health training for family physicians and other nondental providers for almost 2 decades. Our national survey assesses progress of family medicine residency programs on this important health topic since our last survey in 2011. Family medicine residency program directors (PDs) completed an online survey covering various themes including number of hours of oral health (OH) teaching, topics covered, barriers, evaluation, positive influences, and program demographics. Compared to 2011, more PDs feel OH should be addressed by physicians (86% in 2017 vs 79% in 2011), yet fewer programs are teaching OH (81% vs 96%) with fewer hours overall (31% vs 45% with 4 or more hours). Satisfaction with the competence of graduating residents in OH significantly decreased (17% in 2017 vs 32% in 2011). Program directors who report graduates being well prepared to answer board questions on oral health topics are more likely to have an oral health champion (P<0.001) and report satisfaction with the graduates' level of oral health competency (P<0.001). Programs with an oral health champion, or having a relationship with a state or national oral health coalition, or having routine teaching from a dental professional are significantly more likely to have more hours of oral health curriculum (P<0.001). Family medicine PDs are more aware of the importance of oral health, yet less oral health is being taught in residency programs. Developing more faculty oral health champions and connecting programs to dental faculty and coalitions may help reduce this educational void.

  7. Are the French neurology residents satisfied with their training?

    Science.gov (United States)

    Codron, P; Roux, T; Le Guennec, L; Zuber, M

    2015-11-01

    There have been dramatic changes in neurology over the past decade; these advances require a constant adaptation of residents' theoretical and practical training. The French Association of Neurology Residents and the College of Neurology Teachers conducted a national survey to assess the French neurology residents' satisfaction about their training. A 16-item questionnaire was sent via e-mail to French neurology residents completing training in 2014. Data were collected and processed anonymously. Of eligible respondents, 126 returned the survey, representing approximately 40% of all the French neurology residents. Most residents (78%) rated their clinical training favorably. Seventy-two percent reported good to excellent quality teaching of neurology courses from their faculty. However, many residents (40%) felt insufficient their doctoral thesis supervision. All residents intended to enter fellowship training after their residency, and most of them (68%) planned to practice in a medical center. French neurology residents seemed satisfied with the structure and quality of their training program. However, efforts are required to improve management of the doctoral thesis and make private practice more attractive and accessible during the residency. In the future, similar surveys should be scheduled to regularly assess neurology residents' satisfaction and the impact of the forthcoming national and European reforms. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  8. Implementing the 2009 Institute of Medicine recommendations on resident physician work hours, supervision, and safety

    Science.gov (United States)

    Blum, Alexander B; Shea, Sandra; Czeisler, Charles A; Landrigan, Christopher P; Leape, Lucian

    2011-01-01

    Long working hours and sleep deprivation have been a facet of physician training in the US since the advent of the modern residency system. However, the scientific evidence linking fatigue with deficits in human performance, accidents and errors in industries from aeronautics to medicine, nuclear power, and transportation has mounted over the last 40 years. This evidence has also spawned regulations to help ensure public safety across safety-sensitive industries, with the notable exception of medicine. In late 2007, at the behest of the US Congress, the Institute of Medicine embarked on a year-long examination of the scientific evidence linking resident physician sleep deprivation with clinical performance deficits and medical errors. The Institute of Medicine’s report, entitled “Resident duty hours: Enhancing sleep, supervision and safety”, published in January 2009, recommended new limits on resident physician work hours and workload, increased supervision, a heightened focus on resident physician safety, training in structured handovers and quality improvement, more rigorous external oversight of work hours and other aspects of residency training, and the identification of expanded funding sources necessary to implement the recommended reforms successfully and protect the public and resident physicians themselves from preventable harm. Given that resident physicians comprise almost a quarter of all physicians who work in hospitals, and that taxpayers, through Medicare and Medicaid, fund graduate medical education, the public has a deep investment in physician training. Patients expect to receive safe, high-quality care in the nation’s teaching hospitals. Because it is their safety that is at issue, their voices should be central in policy decisions affecting patient safety. It is likewise important to integrate the perspectives of resident physicians, policy makers, and other constituencies in designing new policies. However, since its release

  9. Curriculum for education and training of Medical Physicists in Nuclear Medicine

    DEFF Research Database (Denmark)

    Del Guerra, Alberto; Bardies, Manuel; Belcari, Nicola

    2013-01-01

    and Competence approach along the lines recommended by the European Qualifications Framework. The minimum level expected in each topic in the theoretical knowledge and practical experience sections is intended to bring trainees up to the requirements expected of a Medical Physicist entering the field of Nuclear...... Medicine. CONCLUSIONS: This new joint EANM/EFOMP European guideline curriculum is a further step to harmonise specialist training of Medical Physicists in Nuclear Medicine within Europe. It provides a common framework for national Medical Physics societies to develop or benchmark their own curricula....... The responsibility for the implementation and accreditation of these standards and guidelines resides within national training and regulatory bodies....

  10. Knowledge and misconceptions about immunizations among medical students, pediatric, and family medicine resident.

    Science.gov (United States)

    Tañón, Vilmarie; Borrero, Clarimar; Pedrogo, Yasmín

    2010-01-01

    Previous research has indicated that, despite being the most trusted source of health information, medical students, residents and other health related professionals lack accurate and current knowledge regarding immunization practices. To evaluate medical students and primary care resident knowledge about immunizations. Self-administered survey given to students from four medical schools, Pediatrics residents (2 training programs) and Family Medicine residents (2 programs). Data was analyzed using Statistix 8.0. One-way ANOVA test was used to compare means, and a p-value less than 0.05 was considered statistically significant. Participants (N=376) included 3rd (64%) and 4th (18%) year medical students and a homogenous distribution of 1st, 2nd and 3rd year residents. The mean percent of correct answers about immunizations was 61%. The participants showed poor knowledge about indications (62% correct answers), contraindications (46% correct answers) and myths (71% correct answers). Knowledge about immunizations correlated with higher levels of education (p immunizations followed by books (48%) and the internet (36%). They referred poor exposure to immunizations in clinical settings. Most medical students do not have the expected knowledge about immunization indications and contraindications. Residents were not proficient in immunization contraindications. Both groups had an adequate understanding about vaccination myths. Efforts towards ensuring adequate exposure to immunizations education during training years are needed in order to eliminate one of the barriers to adequate immunizations in children.

  11. The challenges of implementing advanced access for residents in family medicine in Quebec. Do promising strategies exist?

    Science.gov (United States)

    Abou Malham, Sabina; Touati, Nassera; Maillet, Lara; Breton, Mylaine

    2018-12-01

    The advanced access (AA) model is a highly recommended innovation to improve timely access to primary healthcare. Despite that many studies have shown positive impacts for healthcare professionals, and for patients, implementing this model in clinics with a teaching mission for family medicine residents poses specific challenges. To identify these challenges within these clinics, as well as potential strategies to address them. The authors adopted a qualitative multiple case study design, collected data in 2016 using semi-structured interviews (N = 40) with healthcare professionals and clerical staff in four family medicine units in Quebec, and performed a thematic analysis. They validated results through a discussion workshop, involving many family physicians and residents practicing in different regions Results: Five challenges emerged from the data: 1) choosing, organizing residents' patient; 2) managing and balancing residents' appointment schedules; 3) balancing timely access with relational continuity; 4) understanding the AA model; 5) establishing collaborative practices with other health professionals. Several promising strategies were suggested to address these challenges, including clearly defining residents' patient panels; adopting a team-based care approach; incorporating the model into academic curriculum and clinical training; proactive and ongoing education of health professionals, residents, and patients; involving residents in the change process and in adjustment strategies. To meet the challenges of implementing AA, decision-makers should consider exposing residents to AA during academic training and clinical internships, involving them in team work on arrival, engaging them as key actors in the implementation and in intra- and inter-professional collaborative models.

  12. Barriers and facilitators to implementing addiction medicine fellowships: a qualitative study with fellows, medical students, residents and preceptors.

    Science.gov (United States)

    Klimas, J; Small, W; Ahamad, K; Cullen, W; Mead, A; Rieb, L; Wood, E; McNeil, R

    2017-09-20

    Although progress in science has driven advances in addiction medicine, this subject has not been adequately taught to medical trainees and physicians. As a result, there has been poor integration of evidence-based practices in addiction medicine into physician training which has impeded addiction treatment and care. Recently, a number of training initiatives have emerged internationally, including the addiction medicine fellowships in Vancouver, Canada. This study was undertaken to examine barriers and facilitators of implementing addiction medicine fellowships. We interviewed trainees and faculty from clinical and research training programmes in addiction medicine at St Paul's Hospital in Vancouver, Canada (N = 26) about barriers and facilitators to implementation of physician training in addiction medicine. We included medical students, residents, fellows and supervising physicians from a variety of specialities. We analysed interview transcripts thematically by using NVivo software. We identified six domains relating to training implementation: (1) organisational, (2) structural, (3) teacher, (4) learner, (5) patient and (6) community related variables either hindered or fostered addiction medicine education, depending on context. Human resources, variety of rotations, peer support and mentoring fostered implementation of addiction training. Money, time and space limitations hindered implementation. Participant accounts underscored how faculty and staff facilitated the implementation of both the clinical and the research training. Implementation of addiction medicine fellowships appears feasible, although a number of barriers exist. Research into factors within the local/practice environment that shape delivery of education to ensure consistent and quality education scale-up is a priority.

  13. The impact of the night float system on internal medicine residency programs.

    Science.gov (United States)

    Trontell, M C; Carson, J L; Taragin, M I; Duff, A

    1991-01-01

    To study the design, method of implementation, perceived benefits, and problems associated with a night float system. Self-administered questionnaire completed by program directors, which included both structured and open-ended questions. The answers reflect resident and student opinions as well as those of the program directors, since program directors regularly obtain feedback from these groups. The 442 accredited internal medicine residency programs listed in the 1988-89 Directory of Graduate Medical Education Programs. Of the 442 programs, 79% responded, and 30% had experience with a night float system. The most frequent methods for initiating a night float system included: decreasing elective time (42.3%), hiring more residents (26.9%), creating a non-teaching service (12.5%), and reallocating housestaff time (9.6%). Positive effects cited include decreased fatigue, improved housestaff morale, improved recruiting, and better attitude toward internal medicine training. The quality of medical care was considered the same or better by most programs using it. The most commonly cited problems were decreased continuity of care, inadequate teaching of the night float team, and miscommunication. Residency programs using a night float system usually observe a positive effect on housestaff morale, recruitment, and working hours and no detrimental effect on the quality of patient care. Miscommunication and inadequate learning experience for the night float team are important potential problems. This survey suggests that the night float represents one solution to reducing resident working hours.

  14. The role of librarians in teaching evidence-based medicine to pediatric residents: a survey of pediatric residency program directors.

    Science.gov (United States)

    Boykan, Rachel; Jacobson, Robert M

    2017-10-01

    The research sought to identify the general use of medical librarians in pediatric residency training, to define the role of medical librarians in teaching evidence-based medicine (EBM) to pediatric residents, and to describe strategies and curricula for teaching EBM used in pediatric residency training programs. We sent a 13-question web-based survey through the Association of Pediatric Program Directors to 200 pediatric residency program directors between August and December 2015. A total of 91 (46%) pediatric residency program directors responded. Most (76%) programs had formal EBM curricula, and more than 75% of curricula addressed question formation, searching, assessment of validity, generalizability, quantitative importance, statistical significance, and applicability. The venues for teaching EBM that program directors perceived to be most effective included journal clubs (84%), conferences (44%), and morning report (36%). While 80% of programs utilized medical librarians, most of these librarians assisted with scholarly or research projects (74%), addressed clinical questions (62%), and taught on any topic not necessarily EBM (58%). Only 17% of program directors stated that librarians were involved in teaching EBM on a regular basis. The use of a librarian was not associated with having an EBM curriculum but was significantly associated with the size of the program. Smaller programs were more likely to utilize librarians (100%) than were medium (71%) or large programs (75%). While most pediatric residency programs have an EBM curriculum and engage medical librarians in various ways, librarians' expertise in teaching EBM is underutilized. Programs should work to better integrate librarians' expertise, both in the didactic and clinical teaching of EBM.

  15. Opinions of Primary Care Family Physicians About Family Medicine Speciality Training Program

    Directory of Open Access Journals (Sweden)

    Hamit Sirri Keten

    2014-04-01

    Material and Method: A total of 170 family physicians working in Kahramanmaras were included in the study. After obtaining informed consent a questionnaire comprising questions regarding socio-demographic properties, conveying contracted family physicians as family medicine specialists and organization of the training program was applied to participants. Results: Among physicians participating in the study 130 (76.5% were male and 40 (23.5% were female, with a mean age of 40.7±7.1 (min = 26 years, max = 64 years. The mean duration of professional experience of physicians was 15.3±7.0 (min = 2 years, max = 40 years years. Of all, 91 (53.5% participants had already read the decree on family medicine specialist training program for contracted family physicians. A hundred and fifteen (67.6% family physicians supported that Family Medicine Specialty program should be taken part-time without interrupting routine medical tasks. Only 51 (30.0% participants stated the requirement of an entrance examination (TUS for family medicine specialty training. Conclusion: Family medicine specialty training program towards family physicians should be considered in the light of scientific criteria. In family medicine, an area exhibited a holistic approach to the patient; specialty training should be through residency training instead of an education program. For this purpose, family medicine departments in medical faculties should play an active role in this process. Additionally further rotations in needed branches should be implemented with a revision of area should be performed. In medicine practical training is of high importance and distant or part-time education is not appropriate, and specialist training shall be planned in accordance with the medical specialty training regulations. [Cukurova Med J 2014; 39(2.000: 298-304

  16. Teaching and evaluating multitasking ability in emergency medicine residents - what is the best practice?

    Science.gov (United States)

    Heng, Kenneth Wj

    2014-01-01

    Multitasking is an essential skill to develop during Emergency Medicine (EM) residency. Residents who struggle to cope in a multitasking environment risk fatigue, stress, and burnout. Improper management of interruption has been causally linked with medical errors. Formal teaching and evaluation of multitasking is often lacking in EM residency programs. This article reviewed the literature on multitasking in EM to identify best practices for teaching and evaluating multitasking amongst EM residents. With the advancement in understanding of what multitasking is, deliberate attempts should be made to teach residents pitfalls and coping strategies. This can be taught through a formal curriculum, role modeling by faculty, and simulation training. The best way to evaluate multitasking ability in residents is by direct observation. The EM Milestone Project provides a framework by which multitasking can be evaluated. EM residents should be deployed in work environments commiserate with their multitasking ability and their progress should be graduated after identified deficiencies are remediated.

  17. The art of medicine: arts-based training in observation and mindfulness for fostering the empathic response in medical residents.

    Science.gov (United States)

    Zazulak, Joyce; Sanaee, May; Frolic, Andrea; Knibb, Nicole; Tesluk, Eve; Hughes, Edward; Grierson, Lawrence E M

    2017-09-01

    Empathy is an essential attribute for medical professionals. Yet, evidence indicates that medical learners' empathy levels decline dramatically during medical school. Training in evidence-based observation and mindfulness has the potential to bolster the acquisition and demonstration of empathic behaviours for medical learners. In this prospective cohort study, we explore the impact of a course in arts-based visual literacy and mindfulness practice ( Art of Seeing ) on the empathic response of medical residents engaged in obstetrics and gynaecology and family medicine training. Following this multifaceted arts-based programme that integrates the facilitated viewing of art and dance, art-making, and mindfulness-based practices into a practitioner-patient context, 15 resident trainees completed the previously validated Interpersonal Reactivity Index, Compassion, and Mindfulness Scales. Fourteen participants also participated in semistructured interviews that probed their perceived impacts of the programme on their empathic clinical practice. The results indicated that programme participants improved in the Mindfulness Scale domains related to self-confidence and communication relative to a group of control participants following the arts-based programme. However, the majority of the psychometric measures did not reveal differences between groups over the duration of the programme. Importantly, thematic qualitative analysis of the interview data revealed that the programme had a positive impact on the participants' perceived empathy towards colleagues and patients and on the perception of personal and professional well-being. The study concludes that a multifaceted arts-based curriculum focusing on evidence-based observation and mindfulness is a useful tool in bolstering the empathic response, improving communication, and fostering professional well-being among medical residents. Published by the BMJ Publishing Group Limited. For permission to use (where not already

  18. Educational technology improves ECG interpretation of acute myocardial infarction among medical students and emergency medicine residents.

    Science.gov (United States)

    Pourmand, Ali; Tanski, Mary; Davis, Steven; Shokoohi, Hamid; Lucas, Raymond; Zaver, Fareen

    2015-01-01

    Asynchronous online training has become an increasingly popular educational format in the new era of technology-based professional development. We sought to evaluate the impact of an online asynchronous training module on the ability of medical students and emergency medicine (EM) residents to detect electrocardiogram (ECG) abnormalities of an acute myocardial infarction (AMI). We developed an online ECG training and testing module on AMI, with emphasis on recognizing ST elevation myocardial infarction (MI) and early activation of cardiac catheterization resources. Study participants included senior medical students and EM residents at all post-graduate levels rotating in our emergency department (ED). Participants were given a baseline set of ECGs for interpretation. This was followed by a brief interactive online training module on normal ECGs as well as abnormal ECGs representing an acute MI. Participants then underwent a post-test with a set of ECGs in which they had to interpret and decide appropriate intervention including catheterization lab activation. 148 students and 35 EM residents participated in this training in the 2012-2013 academic year. Students and EM residents showed significant improvements in recognizing ECG abnormalities after taking the asynchronous online training module. The mean score on the testing module for students improved from 5.9 (95% CI [5.7-6.1]) to 7.3 (95% CI [7.1-7.5]), with a mean difference of 1.4 (95% CI [1.12-1.68]) (p<0.0001). The mean score for residents improved significantly from 6.5 (95% CI [6.2-6.9]) to 7.8 (95% CI [7.4-8.2]) (p<0.0001). An online interactive module of training improved the ability of medical students and EM residents to correctly recognize the ECG evidence of an acute MI.

  19. Measuring resident well-being: impostorism and burnout syndrome in residency.

    Science.gov (United States)

    Legassie, Jenny; Zibrowski, Elaine M; Goldszmidt, Mark A

    2008-07-01

    Assessing resident well-being is becoming increasingly important from a programmatic standpoint. Two measures that have been used to assess this are the Clance Impostor Scale (CIS) and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). However, little is known about the relationship between the two phenomena. To explore the prevalence and association between impostorism and burnout syndrome in a sample of internal medicine residents. Anonymous, cross-sectional postal survey. Forty-eight internal medicine residents (postgraduate year [PGY] 1-3) at the Schulich School of Medicine & Dentistry (62.3% response rate). Short demographic questionnaire, CIS and MBI-HSS. Impostorism and burnout syndrome were identified in 43.8% and 12.5% of residents, respectively. With the exception of a negative correlation between CIS scores and the MBI's personal accomplishment subscale (r = -.30; 95% CI -.54 to -.02), no other significant relations were identified. Foreign-trained residents were more likely to score as impostors (odds ratio [OR] 10.7; 95% CI 1.2 to 98.2) while senior residents were more likely to experience burnout syndrome (OR 16.5 95% CI 1.6 to 168.5). Both impostorism and burnout syndrome appear to be threats to resident well-being in our program. The lack of relationship between the two would suggest that programs and researchers wishing to address the issue of resident distress should consider using both measures. The finding that foreign-trained residents appear to be more susceptible to impostorism warrants further study.

  20. Family medicine residents’ perceived level of comfort in treating common sports injuries across residency programs in the United States

    Directory of Open Access Journals (Sweden)

    Amoako AO

    2015-03-01

    Full Text Available Adae O Amoako,1 Agyenim B Amoako,2 George GA Pujalte3 1Department of Family and Community Medicine, Penn State Hershey Medical Center, Hershey, PA, USA; 2Department of Family Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA; 3Sports Medicine, Divisions of Primary Care, and Orthopedics, Mayo Clinic Health System, Waycross, GA, USA Background and objective: Family physicians are expected to be comfortable in treating common sports injuries. Evidence shows a limited level of comfort in treating these injuries in pediatric and internal medicine residents. Studies are lacking, however, in family medicine residents. The purpose of this study is to assess the comfort level of family medicine residents in treating common sports injuries in adults and children based on their perceived level of knowledge and attitudes. Methods: This is a cross-sectional study of family medicine residents in the United Sates. A written survey of 25 questions related to sports injury knowledge and factors affecting comfort level were collected. A chi-square test was implemented in calculating P-values. Results: Five hundred and fifty-seven residents responded to the survey. A higher percentage of doctors of osteopathy (86.6%, 82.5%, 69.6%, and 68.7% compared to doctors of medicine (78.5%, 71.6%, 53.4%, and 52.8% respectively identified ankle sprain, concussion, plantar fasciitis, and lateral epicondylitis as common injuries, and felt comfortable in treating them (P-values =0.015, 0.004, 0.0001, and 0.0002, respectively. Residents with high interest in sports medicine correctly identified the injuries as common and felt comfortable treating them as well (knowledge, P=0.027, 0.0029, <0.0001, and 0.0001, respectively; comfort level, P=0.0016, <0.0001, 0.0897, and 0.0010, respectively. Conclusion: Medical education background, factors that affect training, and an interest in sports medicine contribute to residents' knowledge and comfort

  1. Chart Smart: A Need for Documentation and Billing Education Among Emergency Medicine Residents?

    Directory of Open Access Journals (Sweden)

    Brian Dawson, MD

    2010-05-01

    Full Text Available Objective: The healthcare chart is becoming ever more complex, serving clinicians, patients, third party payers, regulators, and even medicolegal parties. The purpose of this study was to identify our emergency medicine (EM resident and attending physicians’ current knowledge and attitudes about billing and documentation practices. We hypothesized that resident and attending physicians would identify billing and documentation as an area in which residents need further education.Methods: We gave a 15-question Likert survey to resident and attending physicians regarding charting practices, knowledge of billing and documentation, and opinions regarding need for further education.Results: We achieved a 100% response rate, with 47% (16/34 of resident physicians disagreeing or strongly disagreeing that they have adequate training in billing and documentation, while 91% (31/34 of residents and 95% (21/22 of attending physicians identified this skill as important to a resident’s future practice. Eighty-two percent (28/34 of resident physicians and 100% of attending physicians recommended further education for residents.Conclusion: Residents in this academic EM department identified a need for further education in billing and documentation practices. [West J Emerg Med. 2010;11(2: 116-119.

  2. Dealing with female sexuality: training, attitude, and practice of obstetrics and gynecology residents from a developing country.

    Science.gov (United States)

    Vieira, Teresa Cristina Souza Barroso; de Souza, Eduardo; da Silva, Ivaldo; Torloni, Maria Regina; Ribeiro, Meireluci Costa; Nakamura, Mary Uchiyama

    2015-05-01

    There is little research on how obstetrics and gynecology (Ob/Gyn) residents deal with female sexuality, especially during pregnancy. The aim of this study was to assess the training, attitude, and practice of Ob/Gyn residents about sexuality. A cross-sectional survey of Brazilian Ob/Gyn residents enrolling in an online sexology course was conducted. A questionnaire assessed their training in sexuality during medical school and residency and their attitude and practice on sexual issues during pregnancy. Training, attitude, and practice of Ob/Gyn residents regarding sexuality were the main outcome measures. A total of 197 residents, from 21 different programs, answered the online questionnaire. Mean age was 27.9 ± 2.2, most were female (87%), single (79%), and had graduated in the last 5 years (91%). Almost two-thirds (63%) stated that they did not receive any training at all and 28% reported having only up to 6 hours of training about sexuality in medical school. Approximately half of the respondents (49%) stated that they had received no formal training about sexuality during their residency up to that moment and 29% had received ≤6 hours of training. Over half (56%) never or rarely took a sexual history, 51% stated that they did not feel competent or confident to answer their pregnant patients' questions about sexuality, and 84% attributed their difficulties in dealing with sexual complaints to their lack of specific knowledge on the topic. The vast majority of Brazilian Ob/Gyn residents enrolling in a sexuality course had little previous formal training on this topic in medical school and during their residency programs. Most residents do not take sexual histories of pregnant patients, do not feel confident in answering questions about sexuality in pregnancy, and attribute these difficulties to lack of knowledge. These findings point to a clear need for additional training in sexuality among Brazilian Ob/Gyn residents. © 2015 International Society for

  3. Adult neurology training during child neurology residency.

    Science.gov (United States)

    Schor, Nina F

    2012-08-21

    As it is currently configured, completion of child neurology residency requires performance of 12 months of training in adult neurology. Exploration of whether or not this duration of training in adult neurology is appropriate for what child neurology is today must take into account the initial reasons for this requirement and the goals of adult neurology training during child neurology residency.

  4. Evaluating the effect of emergency residency training on productivity in the emergency department.

    Science.gov (United States)

    Henning, Daniel J; McGillicuddy, Daniel C; Sanchez, Leon D

    2013-09-01

    Resident productivity, defined as patients seen per unit time, is one measure that is used to assess the performance and educational progress of residents in the emergency department (ED). One published study suggested that emergency residency training (EM) does not improve productivity compared with that in other specialties, including internal medicine (IM). This study assesses how EM and IM trainees perform in the ED and illustrates how resident productivity changes through the academic year. A retrospective review of attending physicians and residents working 8-h shifts in the higher acuity zone of a large-volume, tertiary, academic health care center was performed for July 2009, October 2009, January 2010, and April 2010. The total number of patients seen primarily and admitted during each shift was recorded. ED volume was approximated by the number of patients seen by the attending physician, and acuity was approximated by admission rate. A mixed model regression assessed the impact of year and type of residency training (e.g., EM1, EM2, IM1, and IM2), ED volume, and acuity on resident productivity (number of patients per shift). The study was granted waiver of informed consent by our institutional review board. We reviewed 936 shifts. After adjusting for acuity and ED volume, the EM1 group had a significant increase in patients per shift over the year, from 6.11 in July to 10.3 in April (p increased productivity significantly. The first EM training year leads to a significant change in productivity that separates EM from IM residents. This contradicts the previous assertion that non-EM residents have the same productivity as EM residents in the ED. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. Social Media in the Emergency Medicine Residency Curriculum: Social Media Responses to the Residents' Perspective Article

    OpenAIRE

    Hayes, BD; Kobner, S; Trueger, NS; Yiu, S; Lin, M

    2015-01-01

    © 2015 American College of Emergency Physicians. In July to August 2014, Annals of Emergency Medicine continued a collaboration with an academic Web site, Academic Life in Emergency Medicine (ALiEM), to host an online discussion session featuring the 2014 Annals Residents' Perspective article "Integration of Social Media in Emergency Medicine Residency Curriculum" by Scott et al. The objective was to describe a 14-day worldwide clinician dialogue about evidence, opinions, and early relevant i...

  6. Systems-Based Aspects in the Training of IMG or Previously Trained Residents: Comparison of Psychiatry Residency Training in the United States, Canada, the United Kingdom, India, and Nigeria

    Science.gov (United States)

    Jain, Gaurav; Mazhar, Mir Nadeem; Uga, Aghaegbulam; Punwani, Manisha; Broquet, Karen E.

    2012-01-01

    Objectives: International medical graduates (IMGs) account for a significant proportion of residents in psychiatric training in the United States. Many IMGs may have previously completed psychiatry residency training in other countries. Their experiences may improve our system. Authors compared and contrasted psychiatry residency training in the…

  7. Emergency Medicine Residency Boot Camp Curriculum: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Ataya, Ramsey

    2015-03-01

    Full Text Available Introduction: Establishing a boot camp curriculum is pertinent for emergency medicine (EM residents in order to develop proficiency in a large scope of procedures and leadership skills.  In this article, we describe our program’s EM boot camp curriculum as well as measure the confidence levels of resident physicians through a pre- and post-boot camp survey. Methods: We designed a one-month boot camp curriculum with the intention of improving the confidence, procedural performance, leadership, communication and resource management of EM interns. Our curriculum consisted of 12 hours of initial training and culminated in a two-day boot camp. The initial day consisted of clinical skill training and the second day included code drill scenarios followed by interprofessional debriefing.   Results: Twelve EM interns entered residency with an overall confidence score of 3.2 (1-5 scale across all surveyed skills. Interns reported the highest pre-survey confidence scores in suturing (4.3 and genitourinary exams (3.9. The lowest pre-survey confidence score was in thoracostomy (2.4. Following the capstone experience, overall confidence scores increased to 4.0. Confidence increased the most in defibrillation and thoracostomy. Additionally, all interns reported post-survey confidence scores of at least 3.0 in all skills, representing an internal anchor of “moderately confident/need guidance at times to perform procedure.” Conclusion: At the completion of the boot camp curriculum, EM interns had improvement in self-reported confidence across all surveyed skills and procedures. The described EM boot camp curriculum was effective, feasible and provided a foundation to our trainees during their first month of residency. [West J Emerg Med. 2015;16(2:356–361.

  8. Performance criteria for emergency medicine residents: a job analysis.

    Science.gov (United States)

    Blouin, Danielle; Dagnone, Jeffrey Damon

    2008-11-01

    A major role of admission interviews is to assess a candidate's suitability for a residency program. Structured interviews have greater reliability and validity than do unstructured ones. The development of content for a structured interview is typically based on the dimensions of performance that are perceived as important to succeed in a particular line of work. A formal job analysis is normally conducted to determine these dimensions. The dimensions essential to succeed as an emergency medicine (EM) resident have not yet been studied. We aimed to analyze the work of EM residents to determine these essential dimensions. The "critical incident technique" was used to generate scenarios of poor and excellent resident performance. Two reviewers independently read each scenario and labelled the performance dimensions that were reflected in each. All labels assigned to a particular scenario were pooled and reviewed again until a consensus was reached. Five faculty members (25% of our total faculty) comprised the subject experts. Fifty-one incidents were generated and 50 different labels were applied. Eleven dimensions of performance applied to at least 5 incidents. "Professionalism" was the most valued performance dimension, represented in 56% of the incidents, followed by "self-confidence" (22%), "experience" (20%) and "knowledge" (20%). "Professionalism," "self-confidence," "experience" and "knowledge" were identified as the performance dimensions essential to succeed as an EM resident based on our formal job analysis using the critical incident technique. Performing a formal job analysis may assist training program directors with developing admission interviews.

  9. [Assessment of a residency training program in endocrinology and nutrition by physicians: results of a survey].

    Science.gov (United States)

    Moreno-Fernández, Jesús; Gutiérrez-Alcántara, Carmen; Palomares-Ortega, Rafael; García-Manzanares, Alvaro; Benito-López, Pedro

    2011-12-01

    The current training program for resident physicians in endocrinology and nutrition (EN) organizes their medical learning. Program evaluation by physicians was assessed using a survey. The survey asked about demographic variables, EN training methods, working time and center, and opinion on training program contents. Fifty-one members of Sociedad Castellano-Manchega de Endocrinología, Nutrición y Diabetes, and Sociedad Andaluza de Endocrinología y Nutrición completed the survey. Forty-percent of them disagreed with the compulsory nature of internal medicine, cardiology, nephrology and, especially, neurology rotations (60%); a majority (>50%) were against several recommended rotations included in the program. The fourth year of residence was considered by 37.8% of respondents as the optimum time for outpatient and inpatient control and monitoring without direct supervision. The recommended monthly number of on-call duties was 3.8±1.2. We detected a positive opinion about extension of residence duration to 4.4±0.5 years. Doctoral thesis development during the residence period was not considered convenient by 66.7% of physicians. Finally, 97.8% of resident physicians would recommend residency in EN to other colleagues. Endocrinologists surveyed disagreed with different training program aspects such as the rotation system, skill acquisition timing, and on-call duties. Therefore, an adaptation of the current training program in EN would be required. Copyright © 2011 SEEN. Published by Elsevier Espana. All rights reserved.

  10. Nuclear medicine training and practice in Poland

    International Nuclear Information System (INIS)

    Teresinska, Anna; Birkenfeld, Bozena; Krolicki, Leszek; Dziuk, Miroslaw

    2014-01-01

    In Poland, nuclear medicine (NM) has been an independent specialty since 1988. At the end of 2013, the syllabus for postgraduate specialization in NM has been modified to be in close accordance with the syllabus approved by the European Union of Medical Specialists and is expected to be enforced before the end of 2014. The National Consultant in Nuclear Medicine is responsible for the specialization program in NM. The Medical Center of Postgraduate Training is the administrative body which accepts the specialization programs, supervises the training, organizes the examinations, and awards the specialist title. Specialization in NM for physicians lasts for five years. It consists of 36 months of training in a native nuclear medicine department, 12 months of internship in radiology, 3 months in cardiology, 3 months in endocrinology, 3 months in oncology, and 3 months in two other departments of NM. If a NM trainee is a specialist of a clinical discipline and/or is after a long residency in NM departments, the specialization in NM can be shortened to three years. During the training, there are obligatory courses to be attended which include the elements of anatomy imaging in USG, CT, and MR. Currently, there are about 170 active NM specialists working for 38.5 million inhabitants in Poland. For other professionals working in NM departments, it is possible to get the title of a medical physics specialist after completing 3.5 years of training (for those with a master's in physics, technical physics or biomedical engineering) or the title of a radiopharmacy specialist after completing 3 years of training (for those with a master's in chemistry or biology). At present, the specialization program in NM for nurses is being developed by the Medical Centre of Postgraduate Education. Continuing education and professional development are obligatory for all physicians and governed by the Polish Medical Chamber. The Polish Society of Nuclear Medicine (PTMN) organizes regular

  11. Nuclear medicine training and practice in Poland

    Energy Technology Data Exchange (ETDEWEB)

    Teresinska, Anna [Institute of Cardiology, Department of Nuclear Medicine, Warsaw (Poland); Birkenfeld, Bozena [Pomeranian Medical University, Department of Nuclear Medicine, Szczecin (Poland); Krolicki, Leszek [Warsaw Medical University, Department of Nuclear Medicine, Warsaw (Poland); Dziuk, Miroslaw [Military Institute of Medicine, Department of Nuclear Medicine, Warsaw (Poland)

    2014-10-15

    In Poland, nuclear medicine (NM) has been an independent specialty since 1988. At the end of 2013, the syllabus for postgraduate specialization in NM has been modified to be in close accordance with the syllabus approved by the European Union of Medical Specialists and is expected to be enforced before the end of 2014. The National Consultant in Nuclear Medicine is responsible for the specialization program in NM. The Medical Center of Postgraduate Training is the administrative body which accepts the specialization programs, supervises the training, organizes the examinations, and awards the specialist title. Specialization in NM for physicians lasts for five years. It consists of 36 months of training in a native nuclear medicine department, 12 months of internship in radiology, 3 months in cardiology, 3 months in endocrinology, 3 months in oncology, and 3 months in two other departments of NM. If a NM trainee is a specialist of a clinical discipline and/or is after a long residency in NM departments, the specialization in NM can be shortened to three years. During the training, there are obligatory courses to be attended which include the elements of anatomy imaging in USG, CT, and MR. Currently, there are about 170 active NM specialists working for 38.5 million inhabitants in Poland. For other professionals working in NM departments, it is possible to get the title of a medical physics specialist after completing 3.5 years of training (for those with a master's in physics, technical physics or biomedical engineering) or the title of a radiopharmacy specialist after completing 3 years of training (for those with a master's in chemistry or biology). At present, the specialization program in NM for nurses is being developed by the Medical Centre of Postgraduate Education. Continuing education and professional development are obligatory for all physicians and governed by the Polish Medical Chamber. The Polish Society of Nuclear Medicine (PTMN) organizes

  12. Functional Neuroimaging Correlates of Burnout among Internal Medicine Residents and Faculty Members

    Directory of Open Access Journals (Sweden)

    Steven J Durning

    2013-10-01

    Full Text Available Burnout is prevalent in residency training and practice and is linked to medical error and suboptimal patient care. However, little is known about how burnout affects clinical reasoning, which is essential to safe and effective care. The aim of this study was to examine how burnout modulates brain activity during clinical reasoning in physicians. Using functional Magnetic Resonance Imaging (fMRI, brain activity was assessed in internal medicine residents (n=10 and board-certified internists (faculty, n=17 from the Uniformed Services University (USU while they answered and reflected upon United States Medical Licensing Examination and American Board of Internal Medicine multiple-choice questions. Participants also completed a validated two-item burnout scale, which includes an item assessing emotional exhaustion and an item assessing depersonalization. Whole brain covariate analysis was used to examine blood-oxygen-level-dependent (BOLD signal during answering and reflecting upon clinical problems with respect to burnout scores. Higher depersonalization scores were associated with less BOLD signal in the right dorsolateral prefrontal cortex and middle frontal gyrus during reflecting on clinical problems and less BOLD signal in the bilateral precuneus while answering clinical problems in residents. Higher emotional exhaustion scores were associated with more right posterior cingulate cortex and middle frontal gyrus BOLD signal in residents. Examination of faculty revealed no significant influence of burnout on brain activity. Residents appear to be more susceptible to burnout effects on clinical reasoning, which may indicate that residents may need both cognitive and emotional support to improve quality of life and to optimize performance and learning. These results inform our understanding of mental stress, cognitive control as well as cognitive load theory.

  13. Burnout, coping, and spirituality among internal medicine resident physicians.

    Science.gov (United States)

    Doolittle, Benjamin R; Windish, Donna M; Seelig, Charles B

    2013-06-01

    Burnout in physicians is common, and studies show a prevalence of 30% to 78%. Identifying constructive coping strategies and personal characteristics that protect residents against burnout may be helpful for reducing errors and improving physician satisfaction. We explored the complex relationships between burnout, behaviors, emotional coping, and spirituality among internal medicine and internal medicine-pediatrics residents. We anonymously surveyed 173 internal medicine and medicine-pediatrics residents to explore burnout, coping, and spiritual attitudes. We used 3 validated survey instruments: the Maslach Burnout Inventory, the Carver Coping Orientation to Problems Experienced (COPE) Inventory, and the Hatch Spiritual Involvement and Beliefs Scale (SIBS). A total of 108 (63%) residents participated, with 31 (28%) reporting burnout. Residents who employed strategies of acceptance, active coping, and positive reframing had lower emotional exhaustion and depersonalization (all, P < .03). Residents who reported denial or disengagement had higher emotional exhaustion and depersonalization scores. Personal accomplishment was positively correlated with the SIBS total score (r  =  +.28, P  =  .003), as well as the internal/fluid domain (r  =  +.32, P  =  .001), existential axes (r  =  +.32, P  =  .001), and humility/personal application domain (r  =  +.23, P  =  .02). The humility/personal application domain also was negatively correlated with emotional exhaustion (r  =  -.20, P  =  .04) and depersonalization (r  =  -.25, P  =  .009). No activity or demographic factor affected any burnout domain. Burnout is a heterogeneous syndrome that affects many residents. We identified a range of emotional and spiritual coping strategies that may have protective benefit.

  14. Mindfulness, burnout, and effects on performance evaluations in internal medicine residents

    Directory of Open Access Journals (Sweden)

    Braun SE

    2017-08-01

    Full Text Available Sarah E Braun,1 Stephen M Auerbach,1 Bruce Rybarczyk,1 Bennett Lee,2 Stephanie Call2 1Department of Psychology, School of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA, USA; 2Department of Internal Medicine, Division of General Medicine, Virginia Commonwealth University, Richmond, VA, USA Purpose: Burnout has been documented at high levels in medical residents with negative effects on performance. Some dispositional qualities, like mindfulness, may protect against burnout. The purpose of the present study was to assess burnout prevalence among internal medicine residents at a single institution, examine the relationship between mindfulness and burnout, and provide preliminary findings on the relation between burnout and performance evaluations in internal medicine residents.Methods: Residents (n = 38 completed validated measures of burnout at three time points separated by 2 months and a validated measure of dispositional mindfulness at baseline. Program director end-of-year performance evaluations were also obtained on 22 milestones used to evaluate internal medicine resident performance; notably, these milestones have not yet been validated for research purposes; therefore, the investigation here is exploratory.Results: Overall, 71.1% (n = 27 of the residents met criteria for burnout during the study. Lower scores on the “acting with awareness” facet of dispositional mindfulness significantly predicted meeting burnout criteria χ2(5 = 11.88, p = 0.04. Lastly, meeting burnout criteria significantly predicted performance on three of the performance milestones, with positive effects on milestones from the “system-based practices” and “professionalism” domains and negative effects on a milestone from the “patient care” domain.Conclusion: Burnout rates were high in this sample of internal medicine residents and rates were consistent with other reports of burnout during medical residency. Dispositional

  15. Surgery and Medicine Residents' Perspectives of Morbidity and Mortality Conference: An Interdisciplinary Approach to Improve ACGME Core Competency Compliance.

    Science.gov (United States)

    Flynn-O'Brien, Katherine T; Mandell, Samuel P; Eaton, Erik Van; Schleyer, Anneliese M; McIntyre, Lisa K

    2015-01-01

    Morbidity and mortality conferences (MMCs) are often used to fulfill the Accreditation Council for Graduate Medical Education practice-based learning and improvement (PBLI) competency, but there is variation among institutions and disciplines in their approach to MMCs. The objective of this study is to examine the trainees' perspective and experience with MMCs and adverse patient event (APE) reporting across disciplines to help guide the future implementation of an institution-wide, workflow-embedded, quality improvement (QI) program for PBLI. Between April 1, 2013, and May 8, 2013, surgical and medical residents were given a confidential survey about APE reporting practices and experience with and attitudes toward MMCs and other QI/patient safety initiatives. Descriptive statistics and univariate analyses using the chi-square test for independence were calculated for all variables. Logistic regression and ordered logistic regression were used for nominal and ordinal categorical dependent variables, respectively, to calculate odds of reporting APEs. Qualitative content analysis was used to code free-text responses. A large, multihospital, tertiary academic training program in the Pacific Northwest. Residents in all years of training from the Accreditation Council for Graduate Medical Education-accredited programs in surgery and internal medicine. Survey response rate was 46.2% (126/273). Although most respondents agreed or strongly agreed that knowledge of and involvement in QI/patient safety activities was important to their training (88.1%) and future career (91.3%), only 10.3% regularly or frequently reported APEs to the institution's established electronic incident reporting system. Senior-level residents in both surgery and medicine were more likely to report APEs than more junior-level residents were (odds ratio = 4.8, 95% CI: 3.1-7.5). Surgery residents had a 4.9 (95% CI: 2.3-10.5) times higher odds than medicine residents had to have reported an APE to

  16. The implications of the ADA Amendments Act of 2008 for residency training program administration.

    Science.gov (United States)

    Regenbogen, Alexandra; Recupero, Patricia R

    2012-01-01

    The Americans with Disabilities Act (ADA) is rarely invoked by medical residents in training. Dr. Martin Jakubowski, a family medicine resident with Asperger's disorder, was dismissed for communicating poorly with patients, peers, and supervisors and for issuing dangerous medical orders. In an attempt to become reinstated, he sued under the ADA (Jakubowski v. The Christ Hospital), arguing that the program had failed to make reasonable accommodation for his disability. The Sixth Circuit Court of Appeals ruled in favor of the hospital, finding that although the doctor was disabled under the ADA, he had failed to demonstrate that he was otherwise qualified for the position. This article comments on the ADA Amendments Act of 2008, the Equal Employment Opportunity Commission (EEOC) guidelines from 2011 and their application to medical residency training, and the Accreditation Council for Graduate Medical Education (ACGME) core competencies as essential job functions.

  17. Survey of emergency medicine resident debt status and financial planning preparedness.

    Science.gov (United States)

    Glaspy, Jeffrey N; Ma, O John; Steele, Mark T; Hall, Jacqueline

    2005-01-01

    Most resident physicians accrue significant financial debt throughout their medical and graduate medical education. The objective of this study was to analyze emergency medicine resident debt status, financial planning actions, and educational experiences for financial planning and debt management. A 22-item questionnaire was sent to all 123 Accreditation Council on Graduate Medical Education-accredited emergency medicine residency programs in July 2001. Two follow-up mailings were made to increase the response rate. The survey addressed four areas of resident debt and financial planning: 1) accrued debt, 2) moonlighting activity, 3) financial planning/debt management education, and 4) financial planning actions. Descriptive statistics were used to analyze the data. Survey responses were obtained from 67.4% (1,707/2,532) of emergency medicine residents in 89 of 123 (72.4%) residency programs. Nearly one half (768/1,707) of respondents have accrued more than 100,000 dollars of debt. Fifty-eight percent (990/1,707) of all residents reported that moonlighting would be necessary to meet their financial needs, and more than 33% (640/1,707) presently moonlight to supplement their income. Nearly one half (832/1,707) of residents actively invested money, of which online trading was the most common method (23.3%). Most residents reported that they received no debt management education during residency (82.1%) or medical school (63.7%). Furthermore, 79.1% (1,351/1,707) of residents reported that they received no financial planning lectures during residency, although 84.2% (1,438/1,707) reported that debt management and financial planning education should be available during residency. Most emergency medicine residency programs do not provide their residents with financial planning education. Most residents have accrued significant debt and believe that more financial planning and debt management education is needed during residency.

  18. Residency education through the family medicine morbidity and mortality conference.

    Science.gov (United States)

    Kim, Curi; Fetters, Michael D; Gorenflo, Daniel W

    2006-09-01

    The value of the morbidity and mortality conference (M&MC) has received little examination in the primary care literature. We sought to understand the educational content of M&MCs by examining data from a family medicine training program. Archived morbidity and mortality conference data (July 2001-July 2003) were retrieved from two University of Michigan family medicine adult inpatient services (one community based and one university based). We used chi-square and t test to compare demographic variables and adverse events between hospital sites. We qualitatively analyzed written comments about adverse events. Both family medicine services shared similar diagnoses, patient volume, length of stay, and gender distribution of patients, but the community hospital had an older average patient age (67.9 years versus 52.9 years) and a higher outpatient complication rate. Analysis of the qualitative data revealed patterns of adverse events, such as an association between avoidable admissions and inadequate pain control, that could be improved through educational intervention. Although family medicine residents' experiences in university and community hospitals were comparable, there were differences in patient populations and case complexity. Modifying the M&MC format could enhance its effectiveness as an educational tool about adverse events.

  19. Two birds with one stone: experiences of combining clinical and research training in addiction medicine.

    Science.gov (United States)

    Klimas, J; McNeil, R; Ahamad, K; Mead, A; Rieb, L; Cullen, W; Wood, E; Small, W

    2017-01-23

    Despite a large evidence-base upon which to base clinical practice, most health systems have not combined the training of healthcare providers in addiction medicine and research. As such, addiction care is often lacking, or not based on evidence or best practices. We undertook a qualitative study to assess the experiences of physicians who completed a clinician-scientist training programme in addiction medicine within a hospital setting. We interviewed physicians from the St. Paul's Hospital Goldcorp Addiction Medicine Fellowship and learners from the hospital's academic Addiction Medicine Consult Team in Vancouver, Canada (N = 26). They included psychiatrists, internal medicine and family medicine physicians, faculty, mentors, medical students and residents. All received both addiction medicine and research training. Drawing on Kirkpatrick's model of evaluating training programmes, we analysed the interviews thematically using qualitative data analysis software (Nvivo 10). We identified five themes relating to learning experience that were influential: (i) attitude, (ii) knowledge, (iii) skill, (iv) behaviour and (v) patient outcome. The presence of a supportive learning environment, flexibility in time lines, highly structured rotations, and clear guidance regarding development of research products facilitated clinician-scientist training. Competing priorities, including clinical and family responsibilities, hindered training. Combined training in addiction medicine and research is feasible and acceptable for current doctors and physicians in training. However, there are important barriers to overcome and improved understanding of the experience of addiction physicians in the clinician-scientist track is required to improve curricula and research productivity.

  20. Comparison of Plastic Surgery Residency Training in United States and China.

    Science.gov (United States)

    Zheng, Jianmin; Zhang, Boheng; Yin, Yiqing; Fang, Taolin; Wei, Ning; Lineaweaver, William C; Zhang, Feng

    2015-12-01

    Residency training is internationally recognized as the only way for the physicians to be qualified to practice independently. China has instituted a new residency training program for the specialty of plastic surgery. Meanwhile, plastic surgery residency training programs in the United States are presently in a transition because of restricted work hours. The purpose of this study is to compare the current characteristics of plastic surgery residency training in 2 countries. Flow path, structure, curriculum, operative experience, research, and evaluation of training in 2 countries were measured. The number of required cases was compared quantitatively whereas other aspects were compared qualitatively. Plastic surgery residency training programs in 2 countries differ regarding specific characteristics. Requirements to become a plastic surgery resident in the United States are more rigorous. Ownership structure of the regulatory agency for residency training in 2 countries is diverse. Training duration in the United States is more flexible. Clinical and research training is more practical and the method of evaluation of residency training is more reasonable in the United States. The job opportunities after residency differ substantially between 2 countries. Not every resident has a chance to be an independent surgeon and would require much more training time in China than it does in the United States. Plastic surgery residency training programs in the United States and China have their unique characteristics. The training programs in the United States are more standardized. Both the United States and China may complement each other to create training programs that will ultimately provide high-quality care for all people.

  1. Entry of US Medical School Graduates Into Family Medicine Residencies: 2015-2016.

    Science.gov (United States)

    Kozakowski, Stanley M; Travis, Alexandra; Bentley, Ashley; Fetter, Gerald

    2016-10-01

    This is the 35th national study conducted by the American Academy of Family Physicians (AAFP) that reports retrospectively the percentage of graduates from MD-granting and DO-granting medical schools who entered Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine residency programs as first-year residents. Approximately 8.7% of the 18,929 students graduating from US MD-granting medical schools and 15.5% of the 5,314 students graduating from DO-granting medical schools between July 2014 and June 2015 entered an ACGME family medicine residency in 2015. Together, 10.2% of graduates of MD- and DO-granting schools entered family medicine. Of the 1,640 graduates of the MD-granting medical schools who entered a family medicine residency in 2015, 80% graduated from 70 of the 134 schools (52%). In 2015, DO-granting medical schools graduated 823 into ACGME-accredited family medicine residencies, 80% graduating from 19 of the 32 schools (59%). In aggregate, medical schools west of the Mississippi River represent less than a third of all MD-granting schools but have a rate of students selecting family medicine that is 40% higher than schools located east of the Mississippi. Fifty-one percent (24/47) of states and territories containing medical schools produce 80% of the graduates entering ACGME-accredited family medicine residency programs. A rank order list of MD-granting medical schools was created based on the last 3 years' average percentage of graduates who became family medicine residents, using the 2015 and prior AAFP census data.

  2. Entry of US Medical School Graduates Into Family Medicine Residencies: 2014-2015.

    Science.gov (United States)

    Kozakowski, Stanley M; Fetter, Gerald; Bentley, Ashley

    2015-10-01

    This is the 34th national study conducted by the American Academy of Family Physicians (AAFP) that reports retrospectively the percentage of graduates from US MD-granting and DO-granting medical schools who entered Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine residency programs as first-year residents in 2014. Approximately 8.5% of the 18,241 students graduating from US MD-granting medical schools between July 2013 and June 2014 entered a family medicine residency. Of the 1,458 graduates of the US MD-granting medical schools who entered a family medicine residency in 2014, 80% graduated from 69 of the 131 schools. Eleven schools lacking departments or divisions of family medicine produced only a total of 26 students entering family medicine. In aggregate, medical schools west of the Mississippi River represent less than a third of all US MD-granting schools but have an aggregate rate of students selecting family medicine that is two-thirds higher than schools to the east of the Mississippi. A rank order list of US MD-granting medical schools was created based on the last 3 years' average percentage of graduates who became family medicine residents, using the 2014 and prior AAFP census data. US MD schools continue to fail to produce a primary care workforce, a key measure of social responsibility as measured by their production of graduates entering into family medicine. DO-granting and international medical school graduates filled the majority of ACGME-accredited family medicine first-year resident positions in 2014.

  3. Internal Medicine residents use heuristics to estimate disease probability.

    Science.gov (United States)

    Phang, Sen Han; Ravani, Pietro; Schaefer, Jeffrey; Wright, Bruce; McLaughlin, Kevin

    2015-01-01

    Training in Bayesian reasoning may have limited impact on accuracy of probability estimates. In this study, our goal was to explore whether residents previously exposed to Bayesian reasoning use heuristics rather than Bayesian reasoning to estimate disease probabilities. We predicted that if residents use heuristics then post-test probability estimates would be increased by non-discriminating clinical features or a high anchor for a target condition. We randomized 55 Internal Medicine residents to different versions of four clinical vignettes and asked them to estimate probabilities of target conditions. We manipulated the clinical data for each vignette to be consistent with either 1) using a representative heuristic, by adding non-discriminating prototypical clinical features of the target condition, or 2) using anchoring with adjustment heuristic, by providing a high or low anchor for the target condition. When presented with additional non-discriminating data the odds of diagnosing the target condition were increased (odds ratio (OR) 2.83, 95% confidence interval [1.30, 6.15], p = 0.009). Similarly, the odds of diagnosing the target condition were increased when a high anchor preceded the vignette (OR 2.04, [1.09, 3.81], p = 0.025). Our findings suggest that despite previous exposure to the use of Bayesian reasoning, residents use heuristics, such as the representative heuristic and anchoring with adjustment, to estimate probabilities. Potential reasons for attribute substitution include the relative cognitive ease of heuristics vs. Bayesian reasoning or perhaps residents in their clinical practice use gist traces rather than precise probability estimates when diagnosing.

  4. The State of Evaluation in Internal Medicine Residency

    Science.gov (United States)

    Holmboe, Eric; Beasley, Brent W.

    2008-01-01

    Background There are no nationwide data on the methods residency programs are using to assess trainee competence. The Accreditation Council for Graduate Medical Education (ACGME) has recommended tools that programs can use to evaluate their trainees. It is unknown if programs are adhering to these recommendations. Objective To describe evaluation methods used by our nation’s internal medicine residency programs and assess adherence to ACGME methodological recommendations for evaluation. Design Nationwide survey. Participants All internal medicine programs registered with the Association of Program Directors of Internal Medicine (APDIM). Measurements Descriptive statistics of programs and tools used to evaluate competence; compliance with ACGME recommended evaluative methods. Results The response rate was 70%. Programs were using an average of 4.2–6.0 tools to evaluate their trainees with heavy reliance on rating forms. Direct observation and practice and data-based tools were used much less frequently. Most programs were using at least 1 of the Accreditation Council for Graduate Medical Education (ACGME)’s “most desirable” methods of evaluation for all 6 measures of trainee competence. These programs had higher support staff to resident ratios than programs using less desirable evaluative methods. Conclusions Residency programs are using a large number and variety of tools for evaluating the competence of their trainees. Most are complying with ACGME recommended methods of evaluation especially if the support staff to resident ratio is high. PMID:18612734

  5. The development of a TED-Ed online resident research training program.

    Science.gov (United States)

    Moreau, Katherine A; Pound, Catherine M; Peddle, Beth; Tokarewicz, Jaclyn; Eady, Kaylee

    2014-01-01

    Pediatric health research is important for improving the health and well-being of children and their families. To foster the development of physicians' research competencies, it is vital to integrate practical and context-specific research training into residency programs. To describe the development of a resident research training program at one tertiary care pediatric academic health sciences center in Ontario, Canada. We surveyed residents and pediatricians/research staff to establish the need and content for a resident research training program. Residents and resident research supervisors agreed or strongly agreed that research training is important for residents. However, few residents and supervisors believed that their academic health sciences center provided adequate training and resources to support resident research. As such, an online resident research training program was established. Residents and supervisors agreed that the program should focus on the following topics: 1) critically evaluating research literature, 2) writing a research proposal, 3) submitting an application for research funding, and 4) writing a manuscript. This highly accessible, context-specific, and inexpensive online program model may be of interest and benefit to other residency programs as a means to enhance residents' scholarly roles. A formal evaluation of the research training program is now underway.

  6. The multiple mini-interview for emergency medicine resident selection.

    Science.gov (United States)

    Hopson, Laura R; Burkhardt, John C; Stansfield, R Brent; Vohra, Taher; Turner-Lawrence, Danielle; Losman, Eve D

    2014-04-01

    The Multiple Mini-Interview (MMI) uses multiple, short-structured contacts to evaluate communication and professionalism. It predicts medical school success better than the traditional interview and application. Its acceptability and utility in emergency medicine (EM) residency selection are unknown. We theorized that participants would judge the MMI equal to a traditional unstructured interview and it would provide new information for candidate assessment. Seventy-one interns from 3 programs in the first month of training completed an eight-station MMI focused on EM topics. Pre- and post-surveys assessed reactions. MMI scores were compared with application data. EM grades correlated with MMI performance (F[1, 66] = 4.18; p interview (mean difference = 1.36; p interview and MMI) was preferred over a MMI alone (mean difference = 1.1; p interview, participants were receptive to a mixed-methods interview. The MMI does correlate with performance on the EM clerkship and therefore can measure important abilities for EM success. Future work will determine whether MMI performance predicts residency performance. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Medical residents reflect on their prejudices toward poverty: a photovoice training project.

    Science.gov (United States)

    Loignon, Christine; Boudreault-Fournier, Alexandrine; Truchon, Karoline; Labrousse, Yanouchka; Fortin, Bruno

    2014-12-31

    Clinicians face challenges in delivering care to socioeconomically disadvantaged patients. While both the public and academic sectors recognize the importance of addressing social inequities in healthcare, there is room for improvement in the training of family physicians, who report being ill-equipped to provide care that is responsive to the living conditions of these patients. This study explored: (i) residents' perceptions and experience in relation to providing care for socioeconomically disadvantaged patients, and (ii) how participating in a photovoice study helped them uncover and examine some of their prejudices and assumptions about poverty. We conducted a participatory photovoice study. Participants were four family medicine residents, two medical supervisors, and two researchers. Residents attended six photovoice meetings at which they discussed photos they had taken. In collaboration with the researchers, the participants defined the research questions, took photos, and participated in data analysis and results dissemination. Meetings were recorded and transcribed for analysis, which consisted of coding, peer debriefing, thematic analysis, and interpretation. The medical residents uncovered and examined their own prejudices and misconceptions about poverty. They reported feeling unprepared to provide care to socioeconomically disadvantaged patients. Supported by medical supervisors and researchers, the residents underwent a three-phase reflexive process of: (1) engaging reflexively, (2) break(ing) through, and (3) taking action. The results indicated that medical residents subsequently felt encouraged to adopt a care approach that helped them overcome the social distance between themselves and their socioeconomically disadvantaged patients. This study highlights the importance of providing medical training on issues related to poverty and increasing awareness about social inequalities in medical education to counteract prejudices toward

  8. Effects of a Short Video-Based Resident-as-Teacher Training Toolkit on Resident Teaching.

    Science.gov (United States)

    Ricciotti, Hope A; Freret, Taylor S; Aluko, Ashley; McKeon, Bri Anne; Haviland, Miriam J; Newman, Lori R

    2017-10-01

    To pilot a short video-based resident-as-teacher training toolkit and assess its effect on resident teaching skills in clinical settings. A video-based resident-as-teacher training toolkit was previously developed by educational experts at Beth Israel Deaconess Medical Center, Harvard Medical School. Residents were recruited from two academic hospitals, watched two videos from the toolkit ("Clinical Teaching Skills" and "Effective Clinical Supervision"), and completed an accompanying self-study guide. A novel assessment instrument for evaluating the effect of the toolkit on teaching was created through a modified Delphi process. Before and after the intervention, residents were observed leading a clinical teaching encounter and scored using the 15-item assessment instrument. The primary outcome of interest was the change in number of skills exhibited, which was assessed using the Wilcoxon signed-rank test. Twenty-eight residents from two academic hospitals were enrolled, and 20 (71%) completed all phases of the study. More than one third of residents who volunteered to participate reported no prior formal teacher training. After completing two training modules, residents demonstrated a significant increase in the median number of teaching skills exhibited in a clinical teaching encounter, from 7.5 (interquartile range 6.5-9.5) to 10.0 (interquartile range 9.0-11.5; P<.001). Of the 15 teaching skills assessed, there were significant improvements in asking for the learner's perspective (P=.01), providing feedback (P=.005), and encouraging questions (P=.046). Using a resident-as-teacher video-based toolkit was associated with improvements in teaching skills in residents from multiple specialties.

  9. [Development of an instrument for the surveillance of quality indicators in specialized training in Preventive Medicine and Public Health].

    Science.gov (United States)

    Gil-Borrelli, Christian Carlo; Latasa, Pello; Reques, Laura; Alemán, Guadalupe

    2015-01-01

    This study describes the process of developing an instrument intended for use in assessing satisfaction with the quality of training in preventive medicine and public health for resident physicians. To develop this instrument, the National Survey of Satisfaction with Medical Residency was adapted by an expert panel consisting of 23 resident physicians in preventive medicine and public health belonging to 9 autonomous communities in Spain. The adaptation of the survey to the specialty rotations included new dimensions and items and was evaluated with a 5-point Likert scale. The most important dimensions were planning and the achievement of specific objectives, supervision, delegation of responsibilities, resources and work environment, personal assessment, encouragement, support, and whether the rotation resulted in a publication or research project, etc. The development and utilization of this tool will enable future trainees in preventive medicine and public health to make an informed choice about their training itineraries. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

  10. The development of a TED-Ed online resident research training program

    Directory of Open Access Journals (Sweden)

    Katherine A. Moreau

    2014-12-01

    Full Text Available Background: Pediatric health research is important for improving the health and well-being of children and their families. To foster the development of physicians’ research competencies, it is vital to integrate practical and context-specific research training into residency programs. Purpose: To describe the development of a resident research training program at one tertiary care pediatric academic health sciences center in Ontario, Canada. Methods: We surveyed residents and pediatricians/research staff to establish the need and content for a resident research training program. Results: Residents and resident research supervisors agreed or strongly agreed that research training is important for residents. However, few residents and supervisors believed that their academic health sciences center provided adequate training and resources to support resident research. As such, an online resident research training program was established. Residents and supervisors agreed that the program should focus on the following topics: 1 critically evaluating research literature, 2 writing a research proposal, 3 submitting an application for research funding, and 4 writing a manuscript. Discussion: This highly accessible, context-specific, and inexpensive online program model may be of interest and benefit to other residency programs as a means to enhance residents’ scholarly roles. A formal evaluation of the research training program is now underway.

  11. [Job status after the resident training period in Spain. Analysis of a national survey.

    Science.gov (United States)

    García Sanz, Miguel; Rodríguez Socarrás, Moises; Tortolero Blanco, Leonardo; Pesquera-Ortega, Laura; Colombo, Juan; Gómez Rivas, Juan

    2018-01-01

    Since the establishment of specialization of medicine through the residency system, Spanish health care has sought to maintain a balance between established needs and trained professionals, with the aim of avoiding the deficit or excess of health specialists with its consequences. The objective of the present review is to know the working conditions of urologist specialists at the end of the residency training period. The results of a survey for urologist who completed their residency contract from 2012 to 2016 are presented, assessing working status, academic and working data during the first months after the completion of specialized training. A total of 42 surveys were collected. All respondents had a working contract within 6 months of completing their training. 71% had a temporary contract, most with duration of less than one year. There are more contract numbers in the public health system, although they increase progressively in the private sector. More than half of the respondents were satisfied with their work situation. The work insertion of the recently specialized urologists is high, reaching 100% within 6 months of finishing their specialization. Labor quality issues are not so positive, observing great working instability associated to a high proportion of temporary contracts lower than 6 months.

  12. Resident partnerships: an effective strategy for training in primary care.

    Science.gov (United States)

    Adam, P; Williamson, H A; Zweig, S C; Delzell, J E

    1997-06-01

    To facilitate resident training in the ambulatory setting, a few family practice residency programs use a partnership system to train residents. Partnerships are pairs of residents from the same year that rotate together on inpatient services. We identified and characterized the advantages and disadvantages of partnership programs in family practice residencies. We conducted a national survey of family practice residencies, followed by phone interviews with residency directors of programs with partnerships. A total of 305 of 407 (75%) residencies responded; 10 programs fit our definition of partnership. Program directors were positive about resident partnerships. Benefits included improved outpatient continuity, enhanced medical communication skills, and emotional and intellectual support. Disadvantages were decreased inpatient exposure and difficulty coordinating residents' schedules. Directors were favorable about partnerships, which seem to be an underutilized technique to improve residency training.

  13. Explaining the Learning Experiences of Clinical Procedures of the Internal Medicine Residents at Department of Gastroenterology

    Directory of Open Access Journals (Sweden)

    Mansoureh Taghavinia

    2012-07-01

    Full Text Available Introduction: the method and way of learning and teaching are effective in acquiring clinical skills, and identifying the shortcomings of learning and teaching will lead to better planning. The purpose of this study was to explain the experiences of the learning clinical procedures of the internal medicine residents in gastroenterology department. Methods: qualitative study using content thematic analysis was done. Six fourth-year residents were selected and interviewed considering purposive sampling. The data of the interviews were transcribed and analyzed after rereading. Results: the collected data are divided into three categories: learning and experience with the following four categories (learning time and experiencing, leaning and experiencing times, learning and experiencing opportunities, training and the lack of the training of some procedures. These categories are explained by using some quotes derived from the data. Conclusion: the results of this study suggest that the administrative management of internal residency is poor and should get seriously in implementation and application of intended instructions existing in the prepared program of Medical Education and Specialized Council of internal residency period. The attending physicians and residents must be aware of the content of education program at the beginning of the residency periods and the trainers must try to supervise the residents’ education.

  14. Mixed messages: residents' experiences learning cross-cultural care.

    Science.gov (United States)

    Park, Elyse R; Betancourt, Joseph R; Kim, Minah K; Maina, Angela W; Blumenthal, David; Weissman, Joel S

    2005-09-01

    An Institute of Medicine report issued in 2002 cited cross-cultural training as a mechanism to address racial and ethnic disparities in health care, but little is known about residents' training and capabilities to provide quality care to diverse populations. This article explores a select group of residents' perceptions of their preparedness to deliver quality care to diverse populations. Seven focus groups and ten individual interviews were conducted with 68 residents in locations nationwide. Qualitative analysis of focus-group and individual interview transcripts was performed to assess residents' perceptions of (1) preparedness to deliver care to diverse patients; (2) educational climate; and (3) training experiences. Most residents in this study noted the importance of cross-cultural care yet reported little formal training in this area. Residents wanted more formal training yet expressed concern that culture-specific training could lead to stereotyping. Most residents had developed ad hoc, informal skills to care for diverse patients. Although residents perceived institutional endorsement, they sensed it was a low priority due to lack of time and resources. Residents in this study reported receiving mixed messages about cross-cultural care. They were told it is important, yet they received little formal training and did not have time to treat diverse patients in a culturally sensitive manner. As a result, many developed coping behaviors rather than skills based on formally taught best practices. Training environments need to increase training to enhance residents' preparedness to deliver high-quality cross-cultural care if the medical profession is to achieve the goals set by the Institute of Medicine.

  15. Mindfulness, burnout, and effects on performance evaluations in internal medicine residents.

    Science.gov (United States)

    Braun, Sarah E; Auerbach, Stephen M; Rybarczyk, Bruce; Lee, Bennett; Call, Stephanie

    2017-01-01

    Burnout has been documented at high levels in medical residents with negative effects on performance. Some dispositional qualities, like mindfulness, may protect against burnout. The purpose of the present study was to assess burnout prevalence among internal medicine residents at a single institution, examine the relationship between mindfulness and burnout, and provide preliminary findings on the relation between burnout and performance evaluations in internal medicine residents. Residents (n = 38) completed validated measures of burnout at three time points separated by 2 months and a validated measure of dispositional mindfulness at baseline. Program director end-of-year performance evaluations were also obtained on 22 milestones used to evaluate internal medicine resident performance; notably, these milestones have not yet been validated for research purposes; therefore, the investigation here is exploratory. Overall, 71.1% (n = 27) of the residents met criteria for burnout during the study. Lower scores on the "acting with awareness" facet of dispositional mindfulness significantly predicted meeting burnout criteria χ 2 (5) = 11.88, p = 0.04. Lastly, meeting burnout criteria significantly predicted performance on three of the performance milestones, with positive effects on milestones from the "system-based practices" and "professionalism" domains and negative effects on a milestone from the "patient care" domain. Burnout rates were high in this sample of internal medicine residents and rates were consistent with other reports of burnout during medical residency. Dispositional mindfulness was supported as a protective factor against burnout. Importantly, results from the exploratory investigation of the relationship between burnout and resident evaluations suggested that burnout may improve performance on some domains of resident evaluations while compromising performance on other domains. Implications and directions for future research are discussed.

  16. [Resident evaluation of general surgery training programs].

    Science.gov (United States)

    Espinoza G, Ricardo; Danilla E, Stefan; Valdés G, Fabio; San Francisco R, Ignacio; Llanos L, Osvaldo

    2009-07-01

    The profile of the general surgeon has changed, aiming to incorporate new skills and to develop new specialties. To assess the quality of postgraduate General Surgery training programs given by Chilean universities, the satisfaction of students and their preferences after finishing the training period. A survey with multiple choice and Likert type questions was designed and applied to 77 surgery residents, corresponding to 59% of all residents of general surgery specialization programs of Chilean universities. Fifty five per cent of residents financed with their own resources the specialization program. Thirty nine percent disagreed partially or totally with the objectives and rotations of programs. The opportunity to perform surgical interventions and the support by teachers was well evaluated. However, 23% revealed teacher maltreatment. Fifty six percent performed research activities, 73% expected to continue training in a derived specialty and 69% was satisfied with the training program. Residents considered that the quality and dedication of professors and financing of programs are issues that must be improved. The opportunity to perform surgical interventions, obtaining a salary for their work and teacher support is considered of utmost importance.

  17. Evaluation of a Substance Use Disorder Curriculum for Internal Medicine Residents

    Science.gov (United States)

    Stein, Melissa R.; Arnsten, Julia H.; Parish, Sharon J.; Kunins, Hillary V.

    2011-01-01

    Teaching about diagnosis, treatment, and sequelae of substance use disorders (SUDs) is insufficient in most Internal Medicine residency programs. To address this, the authors developed, implemented, and evaluated a novel and comprehensive SUD curriculum for first year residents (interns) in Internal Medicine, which anchors the ensuing 3-year…

  18. [Patient safety culture in family and community medicine residents in Aragon].

    Science.gov (United States)

    Rodríguez-Cogollo, R; Paredes-Alvarado, I R; Galicia-Flores, T; Barrasa-Villar, J I; Castán-Ruiz, S

    2014-01-01

    having an appropriate patient safety culture is the first recommendation to improve it. The aim of this article is to determine the safety culture in family medicine residents and then to identify improvement strategies. an online cross-sectional survey of residents in family medicine teaching units of Aragon using the translated, validated and adapted to Spanish, Medical Office Survey on Patient Safety Culture (MOSPS) questionnaire. The results were grouped in 12-dimensional responses for analysis, and the mean value of each dimension was calculated. Perceptions were described by Percentages of Positive (PRP) and Negative Responses (PRN) to each dimension. positive results were seen in «the Patient Care Tracking/Follow-up». There were significant differences in the «Information Exchange With Other Settings», «Staff Training» and «Overall Perceptions of Patient Safety and Quality». Study participants viewed «Work Pressure and Pace» negatively. the institutions providing health services, as well as their staff, are increasingly aware of the importance of improving Patient Safety, and the results of this study allowed us to present information that helps identify weaknesses, and to design initiatives and strategies to improve care practices. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

  19. Personal Therapy in Psychiatry Residency Training: A National Survey of Canadian Psychiatry Residents.

    Science.gov (United States)

    Hadjipavlou, George; Halli, Priyanka; Hernandez, Carlos A Sierra; Ogrodniczuk, John S

    2016-02-01

    The authors collected nationally representative data on Canadian residents' experiences with and perspectives on personal psychotherapy in their psychiatric training. A 43-item questionnaire was distributed electronically to all current psychiatry residents in Canada (N = 839). Four hundred residents from every program across Canada returned the survey (response rate 47.7%). The prevalence of personal therapy at any time was 55.3%, with 42.8% receiving personal therapy during residency. Of residents who undertook personal psychotherapy, 59.3% engaged in weekly therapy, 74.1% received psychodynamic psychotherapy, and 81.5% participated in long-term therapy (>1 year). Personal growth, self-understanding, and professional development were the most common reasons for engaging in personal therapy; however, one-third of residents did so to alleviate symptoms of depression, anxiety, or other mental health concerns. Time was the most important factor impeding residents from personal therapy; only 8.8% found stigma to act as a barrier. The vast majority of residents rated their experience with personal therapy as having a positive or very positive impact on their personal life (84.8%) and overall development as psychiatrists (81.8%). For 64% of respondents, personal therapy had an important or very important role in psychiatry residency training. Residents who received personal therapy rated themselves as better able to understand what happens moment by moment during therapy sessions, detect and deal with patients' emotional reactions, and constructively use their personal reactions to patients. Interest in personal therapy remains strong among psychiatry trainees in Canada. Residents who engaged in psychotherapy endorsed greater confidence in psychotherapy and rated their psychotherapy skills more favorably than those who had never been in the patient role, supporting the view of personal therapy as an important adjunct to psychotherapy training during residency.

  20. Association of volume of patient encounters with residents' in-training examination performance.

    Science.gov (United States)

    McCoy, Christopher P; Stenerson, Matthew B; Halvorsen, Andrew J; Homme, Jason H; McDonald, Furman S

    2013-08-01

    Patient care and medical knowledge are Accreditation Council for Graduate Medical Education (ACGME) core competencies. The correlation between amount of patient contact and knowledge acquisition is not known. To determine if a correlation exists between the number of patient encounters and in-training exam (ITE) scores in internal medicine (IM) and pediatric residents at a large academic medical center. Retrospective cohort study Resident physicians at Mayo Clinic from July 2006 to June 2010 in IM (318 resident-years) and pediatrics (66 resident-years). We tabulated patient encounters through review of clinical notes in an electronic medical record during post graduate year (PGY)-1 and PGY-2. Using linear regression models, we investigated associations between ITE score and number of notes during the previous PGY, adjusted for previous ITE score, gender, medical school origin, and conference attendance. For IM, PGY-2 admission and consult encounters in the hospital and specialty clinics had a positive linear association with ITE-3 % score (β = 0.02; p = 0.004). For IM, PGY-1 conference attendance is positively associated with PGY-2 ITE performance. We did not detect a correlation between PGY-1 patient encounters and subsequent ITE scores for IM or pediatric residents. No association was found between IM PGY-2 ITE score and inpatient, outpatient, or total encounters in the first year of training. Resident continuity clinic and total encounters were not associated with change in PGY-3 ITE score. We identified a positive association between hospital and subspecialty encounters during the second year of IM training and subsequent ITE score, such that each additional 50 encounters were associated with an increase of 1 % correct in PGY-3 ITE score after controlling for previous ITE performance and continuity clinic encounters. We did not find a correlation for volume of encounters and medical knowledge for IM PGY-1 residents or the pediatric cohort.

  1. General surgery training and robotics: Are residents improving their skills?

    Science.gov (United States)

    Finnerty, Brendan M; Afaneh, Cheguevara; Aronova, Anna; Fahey, Thomas J; Zarnegar, Rasa

    2016-02-01

    While robotic-assisted operations have become more prevalent, many general surgery residencies do not have a formal robotic training curriculum. We sought to ascertain how well current general surgery training permits acquisition of robotic skills by comparing robotic simulation performance across various training levels. Thirty-six participants were categorized by level of surgical training: eight medical students (MS), ten junior residents (JR), ten mid-level residents (MLR), and eight senior residents (SR). Participants performed three simulation tasks on the da Vinci (®) Skills Simulator (MatchBoard, EnergyDissection, SutureSponge). Each task's scores (0-100) and cumulative scores (0-300) were compared between groups. There were no differences in sex, hand dominance, video gaming history, or prior robotic experience between groups; however, SR was the oldest (p Robotic skillsets acquired during general surgery residency show minimal improvement during the course of training, although laparoscopic experience is correlated with advanced robotic task performance. Changes in residency curricula or pursuit of fellowship training may be warranted for surgeons seeking proficiency.

  2. Female residents experiencing medical errors in general internal medicine: a qualitative study.

    Science.gov (United States)

    Mankaka, Cindy Ottiger; Waeber, Gérard; Gachoud, David

    2014-07-10

    Doctors, especially doctors-in-training such as residents, make errors. They have to face the consequences even though today's approach to errors emphasizes systemic factors. Doctors' individual characteristics play a role in how medical errors are experienced and dealt with. The role of gender has previously been examined in a few quantitative studies that have yielded conflicting results. In the present study, we sought to qualitatively explore the experience of female residents with respect to medical errors. In particular, we explored the coping mechanisms displayed after an error. This study took place in the internal medicine department of a Swiss university hospital. Within a phenomenological framework, semi-structured interviews were conducted with eight female residents in general internal medicine. All interviews were audiotaped, fully transcribed, and thereafter analyzed. Seven main themes emerged from the interviews: (1) A perception that there is an insufficient culture of safety and error; (2) The perceived main causes of errors, which included fatigue, work overload, inadequate level of competences in relation to assigned tasks, and dysfunctional communication; (3) Negative feelings in response to errors, which included different forms of psychological distress; (4) Variable attitudes of the hierarchy toward residents involved in an error; (5) Talking about the error, as the core coping mechanism; (6) Defensive and constructive attitudes toward one's own errors; and (7) Gender-specific experiences in relation to errors. Such experiences consisted in (a) perceptions that male residents were more confident and therefore less affected by errors than their female counterparts and (b) perceptions that sexist attitudes among male supervisors can occur and worsen an already painful experience. This study offers an in-depth account of how female residents specifically experience and cope with medical errors. Our interviews with female residents convey the

  3. Gaps in Radiation Therapy Awareness: Results From an Educational Multi-institutional Survey of US Internal Medicine Residents.

    Science.gov (United States)

    Shaverdian, Narek; Yoo, Sun Mi; Cook, Ryan; Chang, Eric M; Jiang, Naomi; Yuan, Ye; Sandler, Kiri; Steinberg, Michael; Lee, Percy

    2017-08-01

    Internists and primary care providers play a growing role in cancer care. We therefore evaluated the awareness of radiation therapy in general and specifically the clinical utility of stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer (NSCLC) among current US internal medicine residents. A web-based institutional review board-approved multi-institutional survey was distributed to US internal medicine residency programs. The survey evaluated trainee demographic characteristics, baseline radiation oncology awareness, knowledge of the role of SBRT for early-stage NSCLC, and whether the survey successfully improved awareness. Thirty US internal medicine programs participated, with an overall participant response rate of 46% (1177 of 2551). Of the trainees, 93% (n=1076) reported no radiation oncology education in their residency, 39% (n=452) reported confidence in knowing when to consult radiation oncology in an oncologic emergency, and 26% (n=293) reported confidence in knowing when to consult radiation oncology in the setting of a newly diagnosed cancer. Of the participants, 76% (n=850) correctly identified that surgical resection is the standard treatment in operable early-stage NSCLC, but only 50% (n=559) of participants would recommend SBRT to a medically inoperable patient, followed by 31% of participants (n=347) who were unsure of the most appropriate treatment, and 10% (n=117) who recommended waiting to offer palliative therapy. Ninety percent of participants (n=1029) agreed that they would benefit from further training on when to consult radiation oncology. Overall, 96% (n=1072) indicated that the survey increased their knowledge and awareness of the role of SBRT. The majority of participating trainees received no education in radiation oncology in their residency, reported a lack of confidence regarding when to consult radiation oncology, and overwhelmingly agreed that they would benefit from further training. These findings

  4. General surgery residents' perception of robot-assisted procedures during surgical training.

    Science.gov (United States)

    Farivar, Behzad S; Flannagan, Molly; Leitman, I Michael

    2015-01-01

    With the continued expansion of robotically assisted procedures, general surgery residents continue to receive more exposure to this new technology as part of their training. There are currently no guidelines or standardized training requirements for robot-assisted procedures during general surgical residency. The aim of this study was to assess the effect of this new technology on general surgery training from the residents' perspective. An anonymous, national, web-based survey was conducted on residents enrolled in general surgery training in 2013. The survey was sent to 240 Accreditation Council for Graduate Medical Education-approved general surgery training programs. Overall, 64% of the responding residents were men and had an average age of 29 years. Half of the responses were from postgraduate year 1 (PGY1) and PGY2 residents, and the remainder was from the PGY3 level and above. Overall, 50% of the responses were from university training programs, 32% from university-affiliated programs, and 18% from community-based programs. More than 96% of residents noted the availability of the surgical robot system at their training institution. Overall, 63% of residents indicated that they had participated in robotic surgical cases. Most responded that they had assisted in 10 or fewer robotic cases with the most frequent activities being assisting with robotic trocar placement and docking and undocking the robot. Only 18% reported experience with operating the robotic console. More senior residents (PGY3 and above) were involved in robotic cases compared with junior residents (78% vs 48%, p robotic case. Approximately 64% of residents reported that formal training in robotic surgery was important in residency training and 46% of residents indicated that robotic-assisted cases interfered with resident learning. Only 11% felt that robotic-assisted cases would replace conventional laparoscopic surgery in the future. This study illustrates that although the most residents

  5. Shortening the Miles to the Milestones: Connecting EPA-Based Evaluations to ACGME Milestone Reports for Internal Medicine Residency Programs.

    Science.gov (United States)

    Choe, John H; Knight, Christopher L; Stiling, Rebekah; Corning, Kelli; Lock, Keli; Steinberg, Kenneth P

    2016-07-01

    The Next Accreditation System requires internal medicine training programs to provide the Accreditation Council for Graduate Medical Education (ACGME) with semiannual information about each resident's progress in 22 subcompetency domains. Evaluation of resident "trustworthiness" in performing entrustable professional activities (EPAs) may offer a more tangible assessment construct than evaluations based on expectations of usual progression toward competence. However, translating results from EPA-based evaluations into ACGME milestone progress reports has proven to be challenging because the constructs that underlay these two systems differ.The authors describe a process to bridge the gap between rotation-specific EPA-based evaluations and ACGME milestone reporting. Developed at the University of Washington in 2012 and 2013, this method involves mapping EPA-based evaluation responses to "milestone elements," the narrative descriptions within the columns of each of the 22 internal medicine subcompetencies. As faculty members complete EPA-based evaluations, the mapped milestone elements are automatically marked as "confirmed." Programs can maintain a database that tallies the number of times each milestone element is confirmed for a resident; these data can be used to produce graphical displays of resident progress along the internal medicine milestones.Using this count of milestone elements allows programs to bridge the gap between faculty assessments of residents based on rotation-specific observed activities and semiannual ACGME reports based on the internal medicine milestones. Although potentially useful for all programs, this method is especially beneficial to large programs where clinical competency committee members may not have the opportunity for direct observation of all residents.

  6. Training Psychiatry Residents in Psychotherapy: The Role of Manualized Treatments.

    Science.gov (United States)

    Pagano, Joshua; Kyle, Brandon N; Johnson, Toni L; Saeed, Sy Atezaz

    2017-06-01

    Evidence-based treatment and manualized psychotherapy have a recent but rich history. As interest and research have progressed, defining the role of treatment manuals in resident training and clinical practice has become more important. Although there is not a universal definition of treatment manual, most clinicians and researchers agree that treatment manuals are an essential piece of evidence-based therapy, and that despite several limitations, they offer advantages in training residents in psychotherapy. Requirements for resident training in psychotherapy have changed over the years, and treatment manuals offer a simple and straightforward way to meet training requirements. In a search limited to only depression, two treatment manuals emerged with the support of research regarding both clinical practice and resident training. In looking toward the future, it will be important for clinicians to remain updated on further advances in evidence based manualized treatment as a tool for training residents in psychotherapy, including recent developments in online and smartphone based treatments.

  7. Socializing Identity Through Practice: A Mixed Methods Approach to Family Medicine Resident Perspectives on Uncertainty.

    Science.gov (United States)

    Ledford, Christy J W; Cafferty, Lauren A; Seehusen, Dean A

    2015-01-01

    Uncertainty is a central theme in the practice of medicine and particularly primary care. This study explored how family medicine resident physicians react to uncertainty in their practice. This study incorporated a two-phase mixed methods approach, including semi-structured personal interviews (n=21) and longitudinal self-report surveys (n=21) with family medicine residents. Qualitative analysis showed that though residents described uncertainty as an implicit part of their identity, they still developed tactics to minimize or manage uncertainty in their practice. Residents described increasing comfort with uncertainty the longer they practiced and anticipated that growth continuing throughout their careers. Quantitative surveys showed that reactions to uncertainty were more positive over time; however, the difference was not statistically significant. Qualitative and quantitative results show that as family medicine residents practice medicine their perception of uncertainty changes. To reduce uncertainty, residents use relational information-seeking strategies. From a broader view of practice, residents describe uncertainty neutrally, asserting that uncertainty is simply part of the practice of family medicine.

  8. [Structured residency training program for otolaryngology: a trendsetting principle].

    Science.gov (United States)

    Meyer, J E; Wollenberg, B; Schmidt, C

    2008-09-01

    A concept for an ORL residency training program is necessary because of personnel bottlenecks, quality assurance and benchmarkings. We have created a 2.5 years' program, which is based on 6 pillars: 1. Acquisition of the necessary specialist knowledge by the resident in self-study. 2. Weekly attendance of training lectures according to a study timetable, a monthly specialist seminar to discuss case examples. 3. Weekly presentation by the resident on an article from the current literature, alternating with a presentation on cases and a morbidity and mortality conference. 4. Annual 60 min learning target test. 5. Definition of a surgical training calendar oriented to the new national ORL training regulations. 6. Internal operation course with preparative exercises in anatomy and visit to an operations course at a renowned otolaryngology clinic each year. After 2.5 years of the training time a revision course is introduced. In this way a basic training will be guaranteed for all residents, which can be assessed by the annual test. Finally, the construction of a further training curriculum should lead to an improved transparent training, a higher standard of quality and improved staff satisfaction.

  9. [The new postgraduate training program in general internal medicine: implications for the primary care physician].

    Science.gov (United States)

    Monti, Matteo; Gachoud, David

    2010-11-03

    The Swiss postgraduate training program in general internal medicine is now designed as a competency-based curriculum. In other words, by the end of their training, the residents should demonstrate a set of predefined competences. Many of those competences have to be learnt in outpatient settings. Thus, the primary care physicians have more than ever an important role to play in educating tomorrows doctors. A competency-based model of training requires a regular assessment of the residents. The mini-CEX (mini-Clinical Evaluation eXercise) is the assessment tool proposed by the Swiss institute for postgraduate and continuing education. The mini-CEX is based on the direct observation of the trainees performing a specific task, as well as on the ensuing feedback. This article aims at introducing our colleagues in charge of residents to the mini-CEX, which is a useful tool promoting the culture of feedback in medical education.

  10. Residents' perceptions of an integrated longitudinal curriculum: a qualitative study.

    Science.gov (United States)

    Lubitz, Rebecca; Lee, Joseph; Hillier, Loretta M

    2015-01-01

    The purpose of this study was to explore family medicine residents' perceptions of a newly restructured integrated longitudinal curriculum. A purposeful sample of 16 family medicine residents participated in focus group interviews conducted from a grounded theory perspective to identify the characteristics of this training model that contribute to and that challenge learning. Eight key themes were identified: continuity of care, relevance to family medicine, autonomy, program-focused preparation, professional development as facilitated by role modeling, patient volume, clarity of expectations for learners, and logistics. Positive learning experiences were marked by high levels of autonomy, continuity, and relevance to family medicine. Less favorable learning experiences were characterized by limited opportunities for continuity of care, limited relevance to family medicine practice and unclear expectations for the resident's role. Family physician-led learning experiences contributed to residents' understanding of the full scope of family medicine practice, more so than specialist-led experiences. The logistics of implementing the integrated block were challenging and negatively impacted continuity and learning. This study suggests that an integrated longitudinalized family medicine block training model has the potential to support the principles of a longitudinal integrated competency-based curriculum to effectively prepare residents for family medicine practice.

  11. Impact of new duty-hour rules on residency training.

    Science.gov (United States)

    Duran-Nelson, Alisa; Van Camp, Joan; Ling, Louis

    2010-11-01

    On the surface, changing the rules related to the number of hours residents work per day and per week sounds like a good idea. Theoretically, residents who work fewer hours would be less tired and provide better patient care. But even small changes in residency training programs have implications for the quality of the educational experience and the cost of training, as well as patient care. This article highlights the challenges that two Minnesota residency programs are facing as they adapt to the new rules around residents' work hours.

  12. Concurrent Validity Between a Shared Curriculum, the Internal Medicine In-Training Examination, and the American Board of Internal Medicine Certifying Examination.

    Science.gov (United States)

    Sisson, Stephen D; Bertram, Amanda; Yeh, Hsin-Chieh

    2015-03-01

    A core objective of residency education is to facilitate learning, and programs need more curricula and assessment tools with demonstrated validity evidence. We sought to demonstrate concurrent validity between performance on a widely shared, ambulatory curriculum (the Johns Hopkins Internal Medicine Curriculum), the Internal Medicine In-Training Examination (IM-ITE), and the American Board of Internal Medicine Certifying Examination (ABIM-CE). A cohort study of 443 postgraduate year (PGY)-3 residents at 22 academic and community hospital internal medicine residency programs using the curriculum through the Johns Hopkins Internet Learning Center (ILC). Total and percentile rank scores on ILC didactic modules were compared with total and percentile rank scores on the IM-ITE and total scores on the ABIM-CE. The average score on didactic modules was 80.1%; the percentile rank was 53.8. The average IM-ITE score was 64.1% with a percentile rank of 54.8. The average score on the ABIM-CE was 464. Scores on the didactic modules, IM-ITE, and ABIM-CE correlated with each other (P ITE total and percentile rank scores (P ITE percentile rank. Performance on a widely shared ambulatory curriculum is associated with performance on the IM-ITE and the ABIM-CE.

  13. Global health training in US obstetrics and gynaecology residency programmes: perspectives of students, residents and programme directors.

    Science.gov (United States)

    Nathan, Lisa M; Banks, Erika H; Conroy, Erin M; McGinn, Aileen P; Ghartey, Jeny P; Wagner, Sarah A; Merkatz, Irwin R

    2015-12-01

    Benefits of exposure to global health training during medical education are well documented and residents' demand for this training is increasing. Despite this, it is offered by few US obstetrics and gynaecology (OBGYN) residency training programmes. To evaluate interest, perceived importance, predictors of global health interest and barriers to offering global health training among prospective OBGYN residents, current OBGYN residents and US OGBYN residency directors. We designed two questionnaires using Likert scale questions to assess perceived importance of global health training. The first was distributed to current and prospective OBGYN residents interviewing at a US residency programme during 2012-2013. The second questionnaire distributed to US OBGYN programme directors assessed for existing global health programmes and global health training barriers. A composite Global Health Interest/Importance score was tabulated from the Likert scores. Multivariable linear regression was performed to assess for predictors of Global Health Interest/Importance. A total of 159 trainees (77%; 129 prospective OBGYN residents and 30 residents) and 69 (28%) programme directors completed the questionnaires. Median Global Health Interest/Importance score was 7 (IQR 4-9). Prior volunteer experience was predictive of a 5-point increase in Global Health Interest/Importance score (95% CI -0.19 to 9.85; p=0.02). The most commonly cited barriers were cost and time. Interest and perceived importance of global health training in US OBGYN residency programmes is evident among trainees and programme directors; however, significant financial and time barriers prevent many programmes from offering opportunities to their trainees. Prior volunteer experience predicts global health interest. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  14. Are All Competencies Equal in the Eyes of Residents? A Multicenter Study of Emergency Medicine Residents’ Interest in Feedback

    Science.gov (United States)

    Bentley, Suzanne; Hu, Kevin; Messman, Anne; Moadel, Tiffany; Khandelwal, Sorabh; Streich, Heather; Noelker, Joan

    2017-01-01

    Introduction Feedback, particularly real-time feedback, is critical to resident education. The emergency medicine (EM) milestones were developed in 2012 to enhance resident assessment, and many programs use them to provide focused resident feedback. The purpose of this study was to evaluate EM residents’ level of interest in receiving real-time feedback on each of the 23 competencies/sub-competencies. Methods This was a multicenter cross-sectional study of EM residents. We surveyed participants on their level of interest in receiving real-time on-shift feedback on each of the 23 competencies/sub-competencies. Anonymous paper or computerized surveys were distributed to residents at three four-year training programs and three three-year training programs with a total of 223 resident respondents. Residents rated their level of interest in each milestone on a six-point Likert-type response scale. We calculated average level of interest for each of the 23 sub-competencies, for all 223 respondents and separately by postgraduate year (PGY) levels of training. One-way analyses of variance were performed to determine if there were differences in ratings by level of training. Results The overall survey response rate across all institutions was 82%. Emergency stabilization had the highest mean rating (5.47/6), while technology had the lowest rating (3.24/6). However, we observed no differences between levels of training on any of the 23 competencies/sub-competencies. Conclusion Residents seem to ascribe much more value in receiving feedback on domains involving high-risk, challenging procedural skills as compared to low-risk technical and communication skills. Further studies are necessary to determine whether residents’ perceived importance of competencies/sub-competencies needs to be considered when developing an assessment or feedback program based on these 23 EM competencies/sub-competencies. PMID:28116012

  15. Monitoring stress among internal medicine residents: an experience-driven, practical and short measure.

    Science.gov (United States)

    Myszkowski, Nils; Villoing, Barbara; Zenasni, Franck; Jaury, Philippe; Boujut, Emilie

    2017-07-01

    Residents experience severely high levels of stress, depression and burnout, leading to perceived medical errors, as well as to symptoms of impairment, such as chronic anger, cognitive impairment, suicidal behavior and substance abuse. Because research has not yet provided a psychometrically robust population-specific tool to measure the level of stress of medicine residents, we aimed at building and validating such a measure. Using an inductive scale development approach, a short, pragmatic measure was built, based on the interviews of 17 medicine residents. The Internal Medicine Residency Stress Scale (IMRSS) was then administered in a sample of 259 internal medicine residents (199 females, 60 males, M Age  = 25.6) along with the Hospital Anxiety and Depression Scale, Maslach Burnout Inventory, Satisfaction With Life Scale and Ways of Coping Checklist. The IMRSS showed satisfactory internal reliability (Cronbach's α = .86), adequate structural validity - studied through Confirmatory Factor Analysis (χ 2 /df = 2.51, CFI = .94; SRMR = .037, RMSEA = .076) - and good criterion validity - the IMRSS was notably strongly correlated with emotional exhaustion (r = .64; p is recommended to quickly and frequently assess and monitor stress among internal medicine residents.

  16. Impact of the Primary Care Exception on Family Medicine Resident Coding.

    Science.gov (United States)

    Cawse-Lucas, Jeanne; Evans, David V; Ruiz, David R; Allcut, Elizabeth A; Andrilla, C Holly A; Thompson, Matthew; Norris, Thomas E

    2016-03-01

    The Medicare Primary Care Exception (PCE) allows residents to see and bill for less-complex patients independently in the primary care setting, requiring attending physicians only to see patients for higher-level visits and complete physical exams in order to bill for them as such. Primary care residencies apply the PCE in various ways. We investigated the impact of the PCE on resident coding practices. Family medicine residency directors in a five-state region completed a survey regarding interpretation and application of the PCE, including the number of established patient evaluation and management codes entered by residents and attending faculty at their institution. The percentage of high-level codes was compared between residencies using chi-square tests. We analyzed coding data for 125,016 visits from 337 residents and 172 faculty physicians in 15 of 18 eligible family medicine residencies. Among programs applying the PCE criteria to all patients, residents billed 86.7% low-mid complexity and 13.3% high-complexity visits. In programs that only applied the PCE to Medicare patients, residents billed 74.9% low-mid complexity visits and 25.2% high-complexity visits. Attending physicians coded more high-complexity visits at both types of programs. The estimated revenue loss over the 1,650 RRC-required outpatient visits was $2,558.66 per resident and $57,569.85 per year for the average residency in our sample. Residents at family medicine programs that apply the PCE to all patients bill significantly fewer high-complexity visits. This finding leads to compliance and regulatory concerns and suggests significant revenue loss. Further study is required to determine whether this discrepancy also reflects inaccuracy in coding.

  17. Utility of the CORD ECG Database in Evaluating ECG Interpretation by Emergency Medicine Residents

    Directory of Open Access Journals (Sweden)

    Wong, Hubert E

    2002-10-01

    Full Text Available OBJECTIVES: Electrocardiograph (ECG interpretation is a vital component of Emergency Medicine (EM resident education, but few studies have formally examined ECG teaching methods used in residency training. Recently, the Council of EM Residency Directors (CORD developed an Internet database of 395 ECGs that have been extensively peer-reviewed to incorporate all findings and abnormalities. We examined the efficacy of this database in assessing EM residents' skills in ECG interpretation. METHODS: We used the CORD ECG database to evaluate residents at our academic three-year EM residency. Thirteen residents participated, including four first-year, four second-year, and five third-year residents. Twenty ECGs were selected using 14 search criteria representing a broad range of abnormalities, including infarction, rhythm, and conduction abnormalities. Exams were scored based on all abnormalities and findings listed in the teaching points accompanying each ECG. We assigned points to each abnormal finding based on clinical relevance. RESULTS: Out of a total of 183 points in our clinically weighted scoring system, first-year residents scored an average of 99 points (54.1% [9 1- 1191, second-year residents 11 1 points (60.4% [97-1261, and third-year residents 130 points (7 1.0% [94- 1501, p = 0.12. Clinically relevant abnormalities, including anterior and inferior myocardial infarctions, were most frequently diagnosed correctly, while posterior infarction was more frequently missed. Rhythm abnormalities including ventricular and supraventricular tachycardias were most frequently diagnosed correctly, while conduction abnormalities including left bundle branch block and atrioventricular (AV block were more frequently missed. CONCLUSION: The CORD database represents a valuable resource in the assessment and teaching of ECG skills, allowing more precise identification of areas upon which instruction should be further focused or individually tailored. Our

  18. Closing the door on pharma? A national survey of family medicine residencies regarding industry interactions.

    Science.gov (United States)

    Fugh-Berman, Adriane; Brown, Steven R; Trippett, Rachel; Bell, Alicia M; Clark, Paige; Fleg, Anthony; Siwek, Jay

    2011-05-01

    To assess the extent and type of interactions U.S. family medicine residencies permit industry to have with medical students and residents. In 2008, the authors e-mailed a four-question survey to residency directors or coordinators at all 460 accredited U.S. family medicine residencies concerning the types of industry support and interaction permitted. The authors conducted quantitative and qualitative analyses of survey responses and written comments. Residencies that did not permit any industry food, gifts, samples, or support of residency activities were designated "pharma-free." The survey response rate was 62.2% (286/460). Among responding family medicine residencies, 52.1% refused drug samples, 48.6% disallowed industry gifts or food, 68.5% forbade industry-sponsored residency activities, and 44.1% denied industry access to students and residents at the family medicine center. Seventy-five residencies (26.2%) were designated as "pharma-free." Medical-school-based and medical-school-administered residencies were no more likely than community-based residencies to be pharma-free. Among the 211 programs that permitted interaction, 68.7% allowed gifts or food, 61.1% accepted drug samples, 71.1% allowed industry representatives access to trainees in the family medicine center, and 37.9% allowed industry-sponsored residency activities. Respondents commented on challenges inherent to limiting industry interactions. Many programs noted recent changes in plans or practices. Most family medicine residencies limit industry interaction with trainees. Because industry interactions can have adverse effects on rational prescribing, residency programs should assess the benefits and harms of these relationships. Copyright © by the Association of American medical Colleges.

  19. Implementing the 2009 Institute of Medicine recommendations on resident physician work hours, supervision, and safety

    OpenAIRE

    Blum, Alexander B; Shea, Sandra; Czeisler, Charles A; Landrigan, Christopher P; Leape, Lucian

    2011-01-01

    Long working hours and sleep deprivation have been a facet of physician training in the US since the advent of the modern residency system. However, the scientific evidence linking fatigue with deficits in human performance, accidents and errors in industries from aeronautics to medicine, nuclear power, and transportation has mounted over the last 40 years. This evidence has also spawned regulations to help ensure public safety across safety-sensitive industries, with the notable exception of...

  20. An Innovative Clinical Skills “Boot Camp” for Dental Medicine Residents

    Directory of Open Access Journals (Sweden)

    Jenny Castillo

    2017-05-01

    Full Text Available During a 1-year hospital-based residency, dental residents are required to rotate through many departments including surgery, medicine, and emergency medicine. It became apparent that there was a gap between clinical skills knowledge taught in dental school curriculum and skills required for hospital-based patient care. In response, a simulation-based intensive clinical skill “boot camp” was created. The boot camp provided an intensive, interactive 3-day session for the dental residents. During the 3 days, residents were introduced to medical knowledge and skills that were necessary for their inpatient hospital rotations but were lacking in traditional dental school curriculum. Effectiveness of the boot camp was assessed in terms of knowledge base and comfort through presession and postsession surveys. According to resident feedback, this intensive introduction for the dental residents improved their readiness for their inpatient hospital-based residency.

  1. Residency training in the United States: What foreign medical ...

    African Journals Online (AJOL)

    FMGs) planning to pursue post-graduate residency training in the United States of America (USA). While the number of residency training positions is shrinking, and the number of United States graduates has steadily declined over the past ...

  2. Development of a high-value care subscore on the internal medicine in-training examination.

    Science.gov (United States)

    Ryskina, Kira L; Korenstein, Deborah; Weissman, Arlene; Masters, Philip; Alguire, Patrick; Smith, Cynthia D

    2014-11-18

    Although high-value care (HVC) that balances benefits of tests or treatments against potential harms and costs has been a recently emphasized competency for internal medicine (IM) residents, few tools to assess residents' knowledge of HVC are available. To describe the development and initial results of an HVC subscore of the Internal Medicine In-Training Examination (IM-ITE). The HVC concepts were introduced to IM-ITE authors during question development. Three physicians independently reviewed each examination question for selection in the HVC subscore according to 6 HVC principles. The final subscore was determined by consensus. Data from the IM-ITE administered in October 2012 were analyzed at the program level. U.S. IM residency programs. 362 U.S. IM residency programs with IM-ITE data for at least 10 residents. Program-level performance on the HVC subscore was compared with performance on the overall IM-ITE, the Dartmouth Atlas hospital care intensity (HCI) index of the program's primary training hospital, and residents' attitudes about HVC assessed with a voluntary survey. The HVC subscore comprised 38 questions, including 21 (55%) on managing conservatively when appropriate and 14 (37%) on identifying low-value care. Of the 362 U.S. IM programs in the sample, 41% were in a different quartile when ranked based on the HVC subscore compared with overall IM-ITE performance. Rankings by HVC subscore and HCI index were modestly inversely associated, with 30% of programs ranked in the same quartile based on both measures. Knowledge of HVC assessed from examination vignettes may not reflect practice of HVC. Although the HVC subscore has face validity and can contribute to evaluation of residents' HVC knowledge, additional tools are needed to accurately measure residents' proficiency in HVC. None.

  3. Simulation-Based Training for Residents in the Management of Acute Agitation: A Cluster Randomized Controlled Trial.

    Science.gov (United States)

    Vestal, Heather S; Sowden, Gillian; Nejad, Shamim; Stoklosa, Joseph; Valcourt, Stephanie C; Keary, Christopher; Caminis, Argyro; Huffman, Jeff

    2017-02-01

    Simulations are used extensively in medicine to train clinicians to manage high-risk situations. However, to our knowledge, no studies have determined whether this is an effective means of teaching residents to manage acutely agitated patients. This study aimed to determine whether simulation-based training in the management of acute agitation improves resident knowledge and performance, as compared to didactic-based instruction. Following a standard lecture on the management of agitated patients, first-year psychiatry residents were randomized (in clusters of three to four residents) to either the intervention (n = 15) or control arm (n = 11). Residents in the intervention arm then received simulation-based training on the management of acute agitation using a scenario with an agitated standardized patient. Those in the control arm received simulation-based training on a clinical topic unrelated to the management of agitation using a scenario with a non-agitated standardized patient who had suffered a fall. Baseline confidence and knowledge were assessed using pre-intervention self-assessment questionnaires and open-ended clinical case vignettes. Efficacy of the intervention as a teaching tool was assessed with post-intervention open-ended clinical case vignettes and videotaped simulation-based assessment, using a different scenario of an agitated standardized patient. Residents who received the agitation simulation-based training showed significantly greater improvement in knowledge (intervention = 3.0 vs. control = 0.3, p = 0.007, Cohen's d = 1.2) and performance (intervention = 39.6 vs control = 32.5, p = 0.001, Cohen's d = 1.6). Change in self-perceived confidence did not differ significantly between groups. In this study, simulation-based training appeared to be more effective at teaching knowledge and skills necessary for the management of acutely agitated patients, as compared to didactic-based instruction alone

  4. Trends in the Medical Knowledge and Clinical Competence of Graduates of Internal Medicine Residency Training Programs.

    Science.gov (United States)

    Norcini, John J.; And Others

    1991-01-01

    A study assessed the effectiveness of medical resident training programs during 1983-88 by evaluating students' certification scores and comparing them to the program's evaluation of students' clinical competence. Results are reported and analyzed for top-rated, university-affiliated, and non-university-affiliated programs, focusing on trends over…

  5. Social Workers as Workplace-Based Instructors of Alcohol and Drug Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Emergency Medicine Residents.

    Science.gov (United States)

    Duong, David K; O'Sullivan, Patricia S; Satre, Derek D; Soskin, Philippa; Satterfield, Jason

    2016-01-01

    Residency education is challenged by a shortage of personnel and time, particularly for teaching behavioral interventions such as screening, brief intervention, and referral to treatment (SBIRT) to reduce hazardous drinking and drug use. However, social workers may be well placed to teach SBIRT in clinical training settings. We describe a curriculum with social workers as SBIRT trainers of emergency medicine (EM) residents during actual clinical shifts in an EM residency training program. The curriculum required 1 EM faculty member working with social workers and 1 additional hour of formal residency conference teaching time. We implemented the curriculum at both a university tertiary care hospital emergency department and a county trauma center. We trained 8 social workers at both sites as SBIRT superusers to teach and assess EM resident SBIRT performance with actual patients. We measured the length and number of sessions to attain SBIRT competence, residents' satisfaction, and resident comments (coded by authors). Five of the 8 social workers trained residents between June 2013 and May 2014, 31 EM residents trained to a level indicating SBIRT competence with 114 patients. Each patient interaction averaged 8.8 minutes and residents averaged 3.13 patients. Twenty-four (77%) residents gave ratings of 1.58 (SD = .58) for the quality of teaching, 2.33 (SD = .87) for recommending the training to a colleague, 1.38 (SD = .49) for superusers' knowledge, 1.88 (SD = .95) for usefulness of instruction, 1.54 (SD = .72) for workplace learning, and 1.58 (SD = .78) for valuing learning from social workers (on a scale of 1 [very satisfied/strongly agree] to 5 [very dissatisfied/strongly disagree]). Residents preferred learning SBIRT during the 1st and 2nd training years and in the workplace. Social work colleagues can be effective in teaching SBIRT to residents in the workplace, and our residents highly valued learning from social workers, who all had prior training in

  6. Performance of medical residents in sterile techniques during central vein catheterization: randomized trial of efficacy of simulation-based training.

    Science.gov (United States)

    Khouli, Hassan; Jahnes, Katherine; Shapiro, Janet; Rose, Keith; Mathew, Joseph; Gohil, Amit; Han, Qifa; Sotelo, Andre; Jones, James; Aqeel, Adnan; Eden, Edward; Fried, Ethan

    2011-01-01

    Catheter-related bloodstream infection (CRBSI) is a preventable cause of a potentially lethal ICU infection. The optimal method to teach health-care providers correct sterile techniques during central vein catheterization (CVC) remains unclear. We randomly assigned second- and third-year internal medicine residents trained by a traditional apprenticeship model to simulation-based plus video training or video training alone from December 2007 to January 2008, with a follow-up period to examine CRBSI ending in July 2009. During the follow-up period, a simulation-based training program in sterile techniques during CVC was implemented in the medical ICU (MICU). A surgical ICU (SICU) where no residents received study interventions was used for comparison. The primary outcome measures were median residents' scores in sterile techniques and rates of CRBSI per 1,000 catheter-days. Of the 47 enrolled residents, 24 were randomly assigned to the simulation-based plus video training group and 23 to the video training group. Median baseline scores in both groups were equally poor: 12.5 to 13 (52%-54%) out of maximum score of 24 (P = .95; median difference, 0; 95% CI, 0.2-2.0). After training, median score was significantly higher for the simulation-based plus video training group: 22 (92%) vs 18 (75%) for the video training group (P training in sterile techniques during CVC is superior to traditional training or video training alone and is associated with decreased rate of CRBSI. Simulation-based training in CVC should be routinely used to reduce iatrogenic risk. ClinicalTrials.gov; No.: NCT00612131; URL: clinicaltrials.gov.

  7. [French residents' training in instrumental deliveries: A national survey].

    Science.gov (United States)

    Saunier, C; Raimond, E; Dupont, A; Pelissier, A; Bonneau, S; Gabriel, R; Graesslin, O

    2016-11-01

    To evaluate French residents in Obstetrics and Gynaecology's training in instrumental deliveries in 2015. We conducted a national descriptive survey among 758 residents between December 2014 and January 2015. Respondents were invited by email to specify their University Hospital, their current university term, the number of instrumental deliveries performed by vacuum extractor, forceps or spatulas, and whether they made systematic ultrasound exams before performing the extraction. Response rate was 34.7 % (n=263). There were important differences between regions in terms of type of instruments used. Vacuum extractor was the most commonly used instrument for instrumental deliveries by French residents (56.9 %), more than forceps (25.2 %) and spatulas (17.9 %). At the end of the residency, all the residents had been trained in instrumental deliveries with at least two instruments. The training of difficult techniques as well as their perfect control is required for instrumental deliveries. Yet, we are forced to note that there are substantial differences in the French residents' training in instrumental deliveries depending on their region. So, teaching at least two techniques seems essential as well as improving the training capacities and standardizing practices. A greater systematization of the teaching of the mechanics and obstetric techniques might be a solution to be considered too. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  8. Emergency medicine and internal medicine trainees’ smartphone use in clinical settings in the United States

    Directory of Open Access Journals (Sweden)

    Sonja E. Raaum

    2015-10-01

    Full Text Available Purpose: Smartphone technology offers a multitude of applications (apps that provide a wide range of functions for healthcare professionals. Medical trainees are early adopters of this technology, but how they use smartphones in clinical care remains unclear. Our objective was to further characterize smartphone use by medical trainees at two United States academic institutions, as well as their prior training in the clinical use of smartphones. Methods: In 2014, we surveyed 347 internal medicine and emergency medicine resident physicians at the University of Utah and Brigham and Women’s Hospital about their smartphone use and prior training experiences. Scores (0%–100% were calculated to assess the frequency of their use of general features (email, text and patient-specific apps, and the results were compared according to resident level and program using the Mann-Whitney U-test. Results: A total of 184 residents responded (response rate, 53.0%. The average score for using general features, 14.4/20 (72.2% was significantly higher than the average score for using patient-specific features and apps, 14.1/44 (33.0%, P<0.001. The average scores for the use of general features, were significantly higher for year 3–4 residents, 15.0/20 (75.1% than year 1–2 residents, 14.1/20 (70.5%, P=0.035, and for internal medicine residents, 14.9/20 (74.6% in comparison to emergency medicine residents, 12.9/20 (64.3%, P= 0.001. The average score reflecting the use of patient-specific apps was significantly higher for year 3–4 residents, 16.1/44 (36.5% than for year 1–2 residents, 13.7/44 (31.1%; P=0.044. Only 21.7% of respondents had received prior training in clinical smartphone use. Conclusion: Residents used smartphones for general features more frequently than for patient-specific features, but patient-specific use increased with training. Few residents have received prior training in the clinical use of smartphones.

  9. Gender differences in salary of internal medicine residency directors: a national survey.

    Science.gov (United States)

    Willett, Lisa L; Halvorsen, Andrew J; McDonald, Furman S; Chaudhry, Saima I; Arora, Vineet M

    2015-06-01

    Whether salary disparities exist between men and women in medical education leadership roles is not known. The study objective was to determine whether salary disparities exist between male and female Internal Medicine residency program directors, and if so, to identify factors associated with the disparities and explore historical trends. The annual Association of Program Directors in Internal Medicine (APDIM) survey in August 2012 included items to assess the salary and demographic characteristics of program directors, which were merged with publically available program data. To assess historical trends, we used similarly obtained survey data from 2008 to 2011. The study included program directors of 370 APDIM member programs, representing 95.6% of the 387 accredited Internal Medicine training programs in the United States and Puerto Rico. Of the 370 APDIM member programs, 241 (65.1%) completed the survey, of whom 169 (70.1%) were men and 72 (29.9%) were women. Program directors' total annual salary, measured in $25,000 increments, ranged from $75,000 or less to more than $400,000. Historical trends of mode salary by gender from 2008 to 2012 were assessed. The mode salary was $200,000 to 225,000 for men and $175,000 to $200,000 for women (P = .0005). After controlling for academic rank, career in general internal medicine, and program director age, the distribution of salary remained different by gender (P = .004). Historical trends show that the difference in mode salary has persisted since 2008. Leaders in academic medical centers, residency and fellowship directors, and all faculty in medical education need to be aware that salary disparities cited decades ago persist in this sample of medical educators. Closing the gender gap will require continued advocacy for measuring and reporting salary gaps, and changing the culture of academic medical centers. Copyright © 2015 Alliance for Academic Internal Medicine. Published by Elsevier Inc. All rights reserved.

  10. Use of Team-Based Learning Pedagogy for Internal Medicine Ambulatory Resident Teaching.

    Science.gov (United States)

    Balwan, Sandy; Fornari, Alice; DiMarzio, Paola; Verbsky, Jennifer; Pekmezaris, Renee; Stein, Joanna; Chaudhry, Saima

    2015-12-01

    Team-based learning (TBL) is used in undergraduate medical education to facilitate higher-order content learning, promote learner engagement and collaboration, and foster positive learner attitudes. There is a paucity of data on the use of TBL in graduate medical education. Our aim was to assess resident engagement, learning, and faculty/resident satisfaction with TBL in internal medicine residency ambulatory education. Survey and nominal group technique methodologies were used to assess learner engagement and faculty/resident satisfaction. We assessed medical learning using individual (IRAT) and group (GRAT) readiness assurance tests. Residents (N = 111) involved in TBL sessions reported contributing to group discussions and actively discussing the subject material with other residents. Faculty echoed similar responses, and residents and faculty reported a preference for future teaching sessions to be offered using the TBL pedagogy. The average GRAT score was significantly higher than the average IRAT score by 22%. Feedback from our nominal group technique rank ordered the following TBL strengths by both residents and faculty: (1) interactive format, (2) content of sessions, and (3) competitive nature of sessions. We successfully implemented TBL pedagogy in the internal medicine ambulatory residency curriculum, with learning focused on the care of patients in the ambulatory setting. TBL resulted in active resident engagement, facilitated group learning, and increased satisfaction by residents and faculty. To our knowledge this is the first study that implemented a TBL program in an internal medicine residency curriculum.

  11. A Survey of Clinical Skills Evaluation Practices in Internal Medicine Residency Programs.

    Science.gov (United States)

    Blank, Linda L.; And Others

    1984-01-01

    The evaluation processes of 75 internal medicine residencies visited by the American Board of Internal Medicine (ABIM) in 1978-82 are reviewed. The methods of evaluation used by the residencies are described and compared with the findings from an earlier cycle of visits in 1972-75. (Author/MLW)

  12. Residents' perceived needs in communication skills training across in- and outpatient clinical settings.

    Science.gov (United States)

    Junod Perron, Noelle; Sommer, Johanna; Hudelson, Patricia; Demaurex, Florence; Luthy, Christophe; Louis-Simonet, Martine; Nendaz, Mathieu; De Grave, Willem; Dolmans, Diana; Van der Vleuten, Cees

    2009-05-01

    Residents' perceived needs in communication skills training are important to identify before designing context-specific training programmes, since learrners' perceived needs can influence the effectiveness of training. To explore residents' perceptions of their training needs and training experiences around communication skills, and whether these differ between residents training in inpatient and outpatient clinical settings. Four focus groups (FG) and a self-administered questionnaire were conducted with residents working in in- and outpatient medical service settings at a Swiss University Hospital. Focus groups explored residents' perceptions of their communication needs, their past training experiences and suggestions for future training programmes in communication skills. Transcripts were analysed in a thematic way using qualitative analytic approaches. All residents from both settings were asked to complete a questionnaire that queried their sociodemographics and amount of prior training in communication skills. In focus groups, outpatient residents felt that communication skills were especially useful in addressing chronic diseases and social issues. In contrast, inpatient residents emphasized the importance of good communication skills for dealing with family conflicts and end-of-life issues. Felt needs reflected residents' differing service priorities: outpatient residents saw the need for skills to structure the consultation and explore patients' perspectives in order to build therapeutic alliances, whereas inpatient residents wanted techniques to help them break bad news, provide information and increase their own well-being. The survey's overall response rate was 56%. Its data showed that outpatient residents received more training in communication skills and more of them than inpatient residents considered communication skills training to be useful (100% vs 74%). Outpatient residents' perceived needs in communication skills were more patient

  13. Trends in Psychotherapy Training: A National Survey of Psychiatry Residency Training

    Science.gov (United States)

    Sudak, Donna M.; Goldberg, David A.

    2012-01-01

    Objective: The authors sought to determine current trends in residency training of psychiatrists. Method: The authors surveyed U.S. general-psychiatry training directors about the amount of didactic training, supervised clinical experience, and numbers of patients treated in the RRC-mandated models of psychotherapy (psychodynamic,…

  14. Simulation-based interpersonal communication skills training for neurosurgical residents.

    Science.gov (United States)

    Harnof, Sagi; Hadani, Moshe; Ziv, Amitai; Berkenstadt, Haim

    2013-09-01

    Communication skills are an important component of the neurosurgery residency training program. We developed a simulation-based training module for neurosurgery residents in which medical, communication and ethical dilemmas are presented by role-playing actors. To assess the first national simulation-based communication skills training for neurosurgical residents. Eight scenarios covering different aspects of neurosurgery were developed by our team: (1) obtaining informed consent for an elective surgery, (2) discharge of a patient following elective surgery, (3) dealing with an unsatisfied patient, (4) delivering news of intraoperative complications, (5) delivering news of a brain tumor to parents of a 5 year old boy, (6) delivering news of brain death to a family member, (7) obtaining informed consent for urgent surgery from the grandfather of a 7 year old boy with an epidural hematoma, and (8) dealing with a case of child abuse. Fifteen neurosurgery residents from all major medical centers in Israel participated in the training. The session was recorded on video and was followed by videotaped debriefing by a senior neurosurgeon and communication expert and by feedback questionnaires. All trainees participated in two scenarios and observed another two. Participants largely agreed that the actors simulating patients represented real patients and family members and that the videotaped debriefing contributed to the teaching of professional skills. Simulation-based communication skill training is effective, and together with thorough debriefing is an excellent learning and practical method for imparting communication skills to neurosurgery residents. Such simulation-based training will ultimately be part of the national residency program.

  15. Integrative Medicine in Preventive Medicine Education

    OpenAIRE

    Jani, Asim A.; Trask, Jennifer; Ali, Ather

    2015-01-01

    During 2012, the USDHHS?s Health Resources and Services Administration funded 12 accredited preventive medicine residencies to incorporate an evidence-based integrative medicine curriculum into their training programs. It also funded a national coordinating center at the American College of Preventive Medicine, known as the Integrative Medicine in Preventive Medicine Education (IMPriME) Center, to provide technical assistance to the 12 grantees. To help with this task, the IMPriME Center esta...

  16. Role of Pharmacy Residency Training in Career Planning: A Student's Perspective.

    Science.gov (United States)

    McElhaney, Ashley; Weber, Robert J

    2014-12-01

    Pharmacy students typically become more focused on career planning and assessment in the final year of their PharmD training. Weighing career options in the advanced pharmacy practice experience year can be both exciting and stressful. The goal of this article is to provide a primer on how pharmacy students can assess how a residency can fit into career planning. This article will describe the various career paths available to graduating students, highlight ways in which a residency can complement career choices, review the current state of the job market for pharmacists, discuss the current and future plans for residency programs, and present thoughts from some current and former residents on why they chose to complete a residency. Most career paths require some additional training, and a residency provides appropriate experience very quickly compared to on-the-job training. Alternative plans to residency training must also be considered, as there are not enough residency positions for candidates. Directors of pharmacy must consider several factors when giving career advice on pharmacy residency training to pharmacy students; they should provide the students with an honest assessment of their work skills and their abilities to successfully complete a residency. This assessment will help the students to set a plan for improvement and give them a better chance at being matched to a pharmacy residency.

  17. Transgender health care: improving medical students' and residents' training and awareness

    Directory of Open Access Journals (Sweden)

    Dubin SN

    2018-05-01

    Full Text Available Samuel N Dubin,1,* Ian T Nolan,1,* Carl G Streed Jr,2 Richard E Greene,3 Asa E Radix,4 Shane D Morrison5 1NYU School of Medicine, New York, NY, 2Department of Medicine, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, 3Department of Internal Medicine, NYU School of Medicine, 4Callen-Lorde Community Health Center, New York, NY, 5Department of Surgery, Division of Plastic Surgery, University of Washington School of Medicine, Seattle, WA, USA *These authors contributed equally to this work Background: A growing body of research continues to elucidate health inequities experienced by transgender individuals and further underscores the need for medical providers to be appropriately trained to deliver care to this population. Medical education in transgender health can empower physicians to identify and change the systemic barriers to care that cause transgender health inequities as well as improve knowledge about transgender-specific care. Methods: We conducted structured searches of five databases to identify literature related to medical education and transgender health. Of the 1272 papers reviewed, 119 papers were deemed relevant to predefined criteria, medical education, and transgender health topics. Citation tracking was conducted on the 119 papers using Scopus to identify an additional 12 relevant citations (a total of 131 papers. Searches were completed on October 15, 2017 and updated on December 11, 2017. Results: Transgender health has yet to gain widespread curricular exposure, but efforts toward incorporating transgender health into both undergraduate and graduate medical educations are nascent. There is no consensus on the exact educational interventions that should be used to address transgender health. Barriers to increased transgender health exposure include limited curricular time, lack of topic-specific competency among faculty, and underwhelming institutional support. All published

  18. Emergency medicine resident crisis resource management ability: a simulation-based longitudinal study

    Directory of Open Access Journals (Sweden)

    Samuel Clarke

    2014-12-01

    Full Text Available Background: Simulation has been identified as a means of assessing resident physicians’ mastery of technical skills, but there is a lack of evidence for its utility in longitudinal assessments of residents’ non-technical clinical abilities. We evaluated the growth of crisis resource management (CRM skills in the simulation setting using a validated tool, the Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS. We hypothesized that the Ottawa GRS would reflect progressive growth of CRM ability throughout residency. Methods: Forty-five emergency medicine residents were tracked with annual simulation assessments between 2006 and 2011. We used mixed-methods repeated-measures regression analyses to evaluate elements of the Ottawa GRS by level of training to predict performance growth throughout a 3-year residency. Results: Ottawa GRS scores increased over time, and the domains of leadership, problem solving, and resource utilization, in particular, were predictive of overall performance. There was a significant gain in all Ottawa GRS components between postgraduate years 1 and 2, but no significant difference in GRS performance between years 2 and 3. Conclusions: In summary, CRM skills are progressive abilities, and simulation is a useful modality for tracking their development. Modification of this tool may be needed to assess advanced learners’ gains in performance.

  19. Pain medicine: The case for an independent medical specialty and training programs.

    Science.gov (United States)

    Dubois, Michel Y; Follett, Kenneth A

    2014-06-01

    Over the last 30 years, pain has become one of the most dynamic areas of medicine and a public health issue. According to a recent Institute of Medicine report, pain affects approximately 100 million Americans at an estimated annual economic cost of $560 to $635 billion and is poorly treated overall. The American Board of Medical Specialties (ABMS) recognizes a pain subspecialty, but pain care delivery has struggled with increasing demand and developed in an inconsistent and uncoordinated fashion. Pain education is insufficient and highly variable. Multiple pain professional organizations have led to fragmentation of the field and lack of interdisciplinary agreement, resulting in confusion regarding who speaks for pain medicine. In this Perspective, the authors argue that ABMS recognition of pain medicine as an independent medical specialty would provide much needed structure and oversight for the field and would generate credibility for the specialty and its providers among medical peers, payers, regulatory and legislative agencies, and the public at large. The existing system, managed by three ABMS boards, largely excludes other specialties that contribute to pain care, fails to provide leadership from a single professional organization, provides suboptimal training exposure to pain medicine, and lengthens training, which results in inefficient use of time and educational resources. The creation of a primary ABMS conjoint board in pain medicine with its own residency programs and departments would provide better coordinated training, ensure the highest degree of competence of pain medicine specialists, and improve the quality of pain care and patient safety.

  20. Training Methods to Improve Evidence-Based Medicine Skills

    Directory of Open Access Journals (Sweden)

    Filiz Ozyigit

    2010-06-01

    Full Text Available Evidence based medicine (EBM is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. It is estimated that only 15% of medical interventions is evidence-based. Increasing demand, new technological developments, malpractice legislations, a very speed increase in knowledge and knowledge sources push the physicians forward for EBM, but at the same time increase load of physicians by giving them the responsibility to improve their skills. Clinical maneuvers are needed more, as the number of clinical trials and observational studies increase. However, many of the physicians, who are in front row of patient care do not use this increasing evidence. There are several examples related to different training methods in order to improve skills of physicians for evidence based practice. There are many training methods to improve EBM skills and these trainings might be given during medical school, during residency or as continuous trainings to the actual practitioners in the field. It is important to discuss these different training methods in our country as well and encourage dissemination of feasible and effective methods. [TAF Prev Med Bull 2010; 9(3.000: 245-254

  1. Residency Training in Robotic General Surgery: A Survey of Program Directors.

    Science.gov (United States)

    George, Lea C; O'Neill, Rebecca; Merchant, Aziz M

    2018-01-01

    Robotic surgery continues to expand in minimally invasive surgery; however, the literature is insufficient to understand the current training process for general surgery residents. Therefore, the objectives of this study were to identify the current approach to and perspectives on robotic surgery training. An electronic survey was distributed to general surgery program directors identified by the Accreditation Council for Graduate Medical Education website. Multiple choice and open-ended questions regarding current practices and opinions on robotic surgery training in general surgery residency programs were used. 20 program directors were surveyed, a majority being from medium-sized programs (4-7 graduating residents per year). Most respondents (73.68%) had a formal robotic surgery curriculum at their institution, with 63.16% incorporating simulation training. Approximately half of the respondents believe that more time should be dedicated to robotic surgery training (52.63%), with simulation training prior to console use (84.21%). About two-thirds of the respondents (63.16%) believe that a formal robotic surgery curriculum should be established as a part of general surgery residency, with more than half believing that exposure should occur in postgraduate year one (55%). A formal robotics curriculum with simulation training and early surgical exposure for general surgery residents should be given consideration in surgical residency training.

  2. Training Psychiatry Residents in Professionalism in the Digital World.

    Science.gov (United States)

    John, Nadyah Janine; Shelton, P G; Lang, Michael C; Ingersoll, Jennifer

    2017-06-01

    Professionalism is an abstract concept which makes it difficult to define, assess and teach. An additional layer of complexity is added when discussing professionalism in the context of digital technology, the internet and social media - the digital world. Current physicians-in-training (residents and fellows) are digital natives having been raised in a digital, media saturated world. Consequently, their use of digital technology and social media has been unconstrained - a reflection of it being integral to their social construct and identity. Cultivating the professional identity and therefore professionalism is the charge of residency training programs. Residents have shown negative and hostile attitudes to formalized professionalism curricula in training. Approaches to these curricula need to consider the learning style of Millennials and incorporate more active learning techniques that utilize technology. Reviewing landmark position papers, guidelines and scholarly work can therefore be augmented with use of vignettes and technology that are available to residency training programs for use with their Millennial learners.

  3. Urology residents training in laparoscopic surgery. Development of a virtual reality model.

    Science.gov (United States)

    Gutiérrez-Baños, J L; Ballestero-Diego, R; Truan-Cacho, D; Aguilera-Tubet, C; Villanueva-Peña, A; Manuel-Palazuelos, J C

    2015-11-01

    The training and learning of residents in laparoscopic surgery has legal, financial and technological limitations. Simulation is an essential tool in the training of residents as a supplement to their training in laparoscopic surgery. The training should be structured in an appropriate environment, with previously established and clear objectives, taught by professionals with clinical and teaching experience in simulation. The training should be conducted with realistic models using animals and ex-vivo tissue from animals. It is essential to incorporate mechanisms to assess the objectives during the residents' training progress. We present the training model for laparoscopic surgery for urology residents at the University Hospital Valdecilla. The training is conducted at the Virtual Hospital Valdecilla, which is associated with the Center for Medical Simulation in Boston and is accredited by the American College of Surgeons. The model is designed in 3 blocks, basic for R1, intermediate for R2-3 and advanced for R4-5, with 9 training modules. The training is conducted in 4-hour sessions for 4 afternoons, for 3 weeks per year of residence. Residents therefore perform 240 hours of simulated laparoscopic training by the end of the course. For each module, we use structured objective assessments to measure each resident's training progress. Since 2003, 9 urology residents have been trained, in addition to the 5 who are currently in training. The model has undergone changes according to the needs expressed in the student feedback. The acquisition of skills in a virtual reality model has enabled the safe transfer of those skills to actual practice. A laparoscopic surgery training program designed in structured blocks and with progressive complexity provides appropriate training for transferring the skills acquired using this model to an actual scenario while maintaining patient safety. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Integrative Medicine in Preventive Medicine Education

    Science.gov (United States)

    Jani, Asim A.; Trask, Jennifer; Ali, Ather

    2016-01-01

    During 2012, the USDHHS’s Health Resources and Services Administration funded 12 accredited preventive medicine residencies to incorporate an evidence-based integrative medicine curriculum into their training programs. It also funded a national coordinating center at the American College of Preventive Medicine, known as the Integrative Medicine in Preventive Medicine Education (IMPriME) Center, to provide technical assistance to the 12 grantees. To help with this task, the IMPriME Center established a multidisciplinary steering committee, versed in integrative medicine, whose primary aim was to develop integrative medicine core competencies for incorporation into preventive medicine graduate medical education training. The competency development process was informed by central integrative medicine definitions and principles, preventive medicine’s dual role in clinical and population-based prevention, and the burgeoning evidence base of integrative medicine. The steering committee considered an interdisciplinary integrative medicine contextual framework guided by several themes related to workforce development and population health. A list of nine competencies, mapped to the six general domains of competence approved by the Accreditation Council of Graduate Medical Education, was operationalized through an iterative exercise with the 12 grantees in a process that included mapping each site’s competency and curriculum products to the core competencies. The competencies, along with central curricular components informed by grantees’ work presented elsewhere in this supplement, are outlined as a roadmap for residency programs aiming to incorporate integrative medicine content into their curricula. This set of competencies adds to the larger efforts of the IMPriME initiative to facilitate and enhance further curriculum development and implementation by not only the current grantees but other stakeholders in graduate medical education around integrative medicine

  5. Differences in the perception of characteristics of excellence of clinical tutors among residents and consultants at an emergency medicine residency program a qualitative research

    Directory of Open Access Journals (Sweden)

    Muna Saleem Aljahany

    2013-01-01

    Full Text Available Introduction: Defining exactly what characterizes a clinical tutor as excellent and another less effective, is an important task in assessing the effectiveness of clinical training and guiding faculty development. Aim: We aimed to evaluate those characteristics and measure differences in their perception among accomplished and non-accomplished consultants and residents in the Emergency Department. We also compared perceptions between the different groups of participants. Methods: The characteristics measured were extracted from an extensive search of previously published studies summarized in a review article. A qualitative study was conducted, using a 20 item questionnaire piloted from the refined characteristics (good indicator of reliability; Cronbach′s Alpha = 0.86. The questionnaire was distributed among all consultants and residents in Saudi Board of Emergency Medicine. Results: No significant difference between consultants′ and residents′ perception was found. "Sincere" was an exception 87.8% versus 55.1%, P = 0.013. Consultants′ specifications did not seem to affect perception on overall scores and its component sub-scores. Conclusion: Since results showed no relation between accomplished and non-accomplished consultants in perceiving those qualities, we excluded the lack of knowledge of those characteristics as a cause of being accomplished or non-accomplished. We suggest a greater dedication from program developers towards creating more opportunities to involve more consultants in basic Emergency Medicine training.

  6. Why Aren't More Primary Care Residents Going into Primary Care? A Qualitative Study.

    Science.gov (United States)

    Long, Theodore; Chaiyachati, Krisda; Bosu, Olatunde; Sircar, Sohini; Richards, Bradley; Garg, Megha; McGarry, Kelly; Solomon, Sonja; Berman, Rebecca; Curry, Leslie; Moriarty, John; Huot, Stephen

    2016-12-01

    Workforce projections indicate a potential shortage of up to 31,000 adult primary care providers by the year 2025. Approximately 80 % of internal medicine residents and nearly two-thirds of primary care internal medicine residents do not plan to have a career in primary care or general internal medicine. We aimed to explore contextual and programmatic factors within primary care residency training environments that may influence career choices. This was a qualitative study based on semi-structured, in-person interviews. Three primary care internal medicine residency programs were purposefully selected to represent a diversity of training environments. Second and third year residents were interviewed. We used a survey guide developed from pilot interviews and existing literature. Three members of the research team independently coded the transcripts and developed the code structure based on the constant comparative method. The research team identified emerging themes and refined codes. ATLAS.ti was used for the analysis. We completed 24 interviews (12 second-year residents, and 12 third-year residents). The age range was 27-39 years. Four recurrent themes characterized contextual and programmatic factors contributing to residents' decision-making: resident expectations of a career in primary care, navigation of the boundary between social needs and medical needs, mentorship and perceptions of primary care, and structural features of the training program. Addressing aspects of training that may discourage residents from careers in primary care such as lack of diversity in outpatient experiences and resident frustration with their inability to address social needs of patients, and strengthening aspects of training that may encourage interests in careers in primary care such as mentorship and protected time away from inpatient responsibilities during primary care rotations, may increase the proportion of residents enrolled in primary care training programs who pursue

  7. Performance of internal medicine residents in the primary interpretation of musculoskeletal radiographs in an ambulatory care setting

    International Nuclear Information System (INIS)

    Mann, F.A.; Stewart, N.R.; Terrell, C.B.

    1990-01-01

    This paper determines the characteristics of misinterpretations of musculoskeletal radiographs by internal medicine residents (IMRs) in an ambulatory care setting. Discordances between IMRs and staff radiologists were prospectively identified and retrospectively reviewed to assess type of error and patient outcome. The setting was an acute ambulatory care clinic at a large university hospital staffed by board-certified emergency medicine faculty and IMRs. Of 541 patients radiographed, 321 (59%) had adequate follow-up to establish outcome. Error characteristics examined included nature and site, type (false negative ([F-] or false positive [F+]), clinical significance, interpreter responsible, and level of interpreter training

  8. Does Spanish instruction for emergency medicine resident physicians improve patient satisfaction in the emergency department and adherence to medical recommendations?

    Directory of Open Access Journals (Sweden)

    Stoneking LR

    2016-08-01

    Full Text Available LR Stoneking,1 AL Waterbrook,1 J Garst Orozco,2 D Johnston,1 A Bellafiore,1 C Davies,3 T Nuño,1 J Fatás-Cabeza,4 O Beita,5 V Ng,1 KH Grall,6 W Adamas-Rappaport7 1Department of Emergency Medicine, University of Arizona, Tucson, AZ, 2Department of Emergency Medicine, Sinai Health System, Chicago, IL, 3Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ, 4Department of Spanish and Portuguese, University of Arizona, Tucson, AZ, 5Department of Family and Community Medicine, University of Arizona, Tucson, AZ, 6Department of Emergency Medicine, Regions Hospital, St Paul, MN, 7Department of Surgery, University of Arizona, Tucson, AZ, USA Background: After emergency department (ED discharge, Spanish-speaking patients with limited English proficiency are less likely than English-proficient patients to be adherent to medical recommendations and are more likely to be dissatisfied with their visit.Objectives: To determine if integrating a longitudinal medical Spanish and cultural competency curriculum into emergency medicine residency didactics improves patient satisfaction and adherence to medical recommendations in Spanish-speaking patients with limited English proficiency.Methods: Our ED has two Emergency Medicine Residency Programs, University Campus (UC and South Campus (SC. SC program incorporates a medical Spanish and cultural competency curriculum into their didactics. Real-time Spanish surveys were collected at SC ED on patients who self-identified as primarily Spanish-speaking during registration and who were treated by resident physicians from both residency programs. Surveys assessed whether the treating resident physician communicated in the patient’s native Spanish language. Follow-up phone calls assessed patient satisfaction and adherence to discharge instructions.Results: Sixty-three patients self-identified as primarily Spanish-speaking from August 2014 to July 2015 and were initially included in this pilot study

  9. Challenges of pediatric residency training in Taiwan.

    Science.gov (United States)

    Tsai, Tsuen-Chiuan; Harasym, Peter H

    2006-01-01

    A crisis in pediatric residency training today has raised serious concerns about the healthcare quality for children in Taiwan. The purpose of this study was to document the problems and to propose possible solutions for improvement. The problems include: 1) manpower shortage due to the difficulty of recruiting pediatric residents; 2) heavy workload that hinders learning; 3) lack of assessment and poor program planning; and 4) inadequate institutional and financial support. As a result, physicians' competencies are not guaranteed at the end of residency training, even with the pediatric board certification. Possible solutions may include: 1) conducting research on physician manpower statistics, work hours and environment; 2) establishing a Residency Program Review Committee and provision of standards for accreditation; 3) defining the competencies mandated as a general pediatrician and developing a set of measurable qualitative standards; 4) encouraging new programs with flexibility (e.g., primary care); and 5) pursuing adequate institutional and financial supports.

  10. Cosmetic dermatologic surgical training in US dermatology residency programs: identifying and overcoming barriers.

    Science.gov (United States)

    Bauer, Bruce; Williams, Erin; Stratman, Erik J

    2014-02-01

    The public and other medical specialties expect dermatologists who offer cosmetic dermatology services to provide competent care. There are numerous barriers to achieving cosmetic dermatology competency during residency. Many dermatology residents enter the workforce planning to provide cosmetic services. If a training gap exists, this may adversely affect patient safety. To identify resources available for hands-on cosmetic dermatology training in US dermatology residency training programs and to assess program director (PD) attitudes toward cosmetic dermatology training during residency and strategies, including discounted pricing, used by training programs to overcome barriers related to resident-performed cosmetic dermatology procedures. An online survey in academic dermatology practices among PDs of US dermatology residency programs. Frequency of cosmetic dermatology devices and injectables used for dermatology resident hands-on cosmetic dermatology training, categorizing PD attitudes toward cosmetic dermatology training during residency and describing residency-related discounted pricing models. Responses from PDs were received from 53 of 114 (46%) US dermatology residency programs. All but 3 programs (94%) offered hands-on cosmetic dermatology training using botulinum toxin, and 47 of 53 (89%) provided training with hyaluronic acid fillers. Pulsed dye lasers represented the most common laser use experienced by residents (41 of 52 [79%]), followed by Q-switched Nd:YAG (30 of 52 [58%]). Discounted procedures were offered by 32 of 53 (60%) programs, with botulinum toxin (30 of 32 [94%]) and fillers (27 of 32 [84%]) most prevalent and with vascular lasers (17 of 32 [53%]) and hair removal lasers (12 of 32 [38%]) less common. Various discounting methods were used. Only 20 of 53 (38%) PDs believed that cosmetic dermatology should be a necessary aspect of residency training; 14 of 52 (27%) PDs thought that residents should not be required to perform any cosmetic

  11. Evaluation of Social Media Use by Emergency Medicine Residents and Faculty.

    Science.gov (United States)

    Pearson, David; Bond, Michael C; Kegg, Jason; Pillow, Tyson; Hopson, Laura; Cooney, Robert; Garg, Manish; Khadpe, Jay; Runyon, Michael; Patterson, Leigh

    2015-09-01

    Clinicians and residency programs are increasing their use of social media (SM) websites for educational and promotional uses, yet little is known about the use of these sites by residents and faculty. The objective of the study is to assess patterns of SM use for personal and professional purposes among emergency medicine (EM) residents and faculty. In this multi-site study, an 18-question survey was sent by e-mail to the residents and faculty in 14 EM programs and to the Council of Emergency Medicine Residency Directors (CORD) listserv via the online tool SurveyMonkey™. We compiled descriptive statistics, including assessment with the chi-square test or Fisher's exact test. StatsDirect software (v 2.8.0, StatsDirect, Cheshire, UK) was used for all analyses. We received 1,314 responses: 63% of respondents were male, 40% were respondents completed residency more than 10 years ago. Residents used SM markedly more than faculty for social interactions with family and friends (83% vs 65% [psocial media. Awareness of these utilization patterns could benefit future educational endeavors.

  12. Residency Training in Robotic General Surgery: A Survey of Program Directors

    Directory of Open Access Journals (Sweden)

    Lea C. George

    2018-01-01

    Full Text Available Objective. Robotic surgery continues to expand in minimally invasive surgery; however, the literature is insufficient to understand the current training process for general surgery residents. Therefore, the objectives of this study were to identify the current approach to and perspectives on robotic surgery training. Methods. An electronic survey was distributed to general surgery program directors identified by the Accreditation Council for Graduate Medical Education website. Multiple choice and open-ended questions regarding current practices and opinions on robotic surgery training in general surgery residency programs were used. Results. 20 program directors were surveyed, a majority being from medium-sized programs (4–7 graduating residents per year. Most respondents (73.68% had a formal robotic surgery curriculum at their institution, with 63.16% incorporating simulation training. Approximately half of the respondents believe that more time should be dedicated to robotic surgery training (52.63%, with simulation training prior to console use (84.21%. About two-thirds of the respondents (63.16% believe that a formal robotic surgery curriculum should be established as a part of general surgery residency, with more than half believing that exposure should occur in postgraduate year one (55%. Conclusion. A formal robotics curriculum with simulation training and early surgical exposure for general surgery residents should be given consideration in surgical residency training.

  13. Results of the 2005-2008 Association of Residents in Radiation Oncology Survey of Chief Residents in the United States: Clinical Training and Resident Working Conditions

    International Nuclear Information System (INIS)

    Gondi, Vinai; Bernard, Johnny Ray; Jabbari, Siavash; Keam, Jennifer; Amorim Bernstein, Karen L. de; Dad, Luqman K.; Li, Linna; Poppe, Matthew M.; Strauss, Jonathan B.; Chollet, Casey T.

    2011-01-01

    Purpose: To document clinical training and resident working conditions reported by chief residents during their residency. Methods and Materials: During the academic years 2005 to 2006, 2006 to 2007, and 2007 to 2008, the Association of Residents in Radiation Oncology conducted a nationwide survey of all radiation oncology chief residents in the United States. Chi-square statistics were used to assess changes in clinical training and resident working conditions over time. Results: Surveys were completed by representatives from 55 programs (response rate, 71.4%) in 2005 to 2006, 60 programs (75.9%) in 2006 to 2007, and 74 programs (93.7%) in 2007 to 2008. Nearly all chief residents reported receiving adequate clinical experience in commonly treated disease sites, such as breast and genitourinary malignancies; and commonly performed procedures, such as three-dimensional conformal radiotherapy and intensity-modulated radiotherapy. Clinical experience in extracranial stereotactic radiotherapy increased over time (p < 0.001), whereas clinical experience in endovascular brachytherapy (p <0.001) decreased over time. The distribution of gynecologic and prostate brachytherapy cases remained stable, while clinical case load in breast brachytherapy increased (p = 0.006). A small but significant percentage of residents reported receiving inadequate clinical experience in pediatrics, seeing 10 or fewer pediatric cases during the course of residency. Procedures involving higher capital costs, such as particle beam therapy and intraoperative radiotherapy, and infrequent clinical use, such as head and neck brachytherapy, were limited to a minority of institutions. Most residency programs associated with at least one satellite facility have incorporated resident rotations into their clinical training, and the majority of residents at these programs find them valuable experiences. The majority of residents reported working 60 or fewer hours per week on required clinical duties

  14. Resident Training in Bariatric Surgery-A National Survey in the Netherlands.

    Science.gov (United States)

    van Ramshorst, Gabrielle H; Kaijser, Mirjam A; Pierie, Jean-Pierre E N; van Wagensveld, Bart A

    2017-11-01

    Surgical procedures for morbid obesity, including laparoscopic Roux-en-Y gastric bypass (LRYGB), are considered standardized laparoscopic procedures. Our goal was to determine how bariatric surgery is trained in the Netherlands. Questionnaires were sent to lead surgeons from all 19 bariatric centers in the Netherlands. At least two residents or fellows were surveyed for each center. Dutch residents are required to collect at least 20 electronic Objective Standard Assessment of Technical Skills (OSATS) observations per year, which include the level of supervision needed for specific procedures. Centers without resident accreditation were excluded. All 19 surgeons responded (100%). Answers from respondents who worked at teaching hospitals with residency accreditation (12/19, 63%) were analyzed. The average number of trained residents or fellows was 14 (range 3-33). Preferred procedures were LRYGB (n = 10), laparoscopic gastric sleeve (LGS) resection (n = 1), or no preference (n = 1). Three groups could be discerned for the order in which procedural steps were trained: unstructured, in order of increasing difficulty, or in order of chronology. Questionnaire response was 79% (19/24) for residents and 73% (8/11) for fellows. On average, residents started training in bariatric surgery in postgraduate year (PGY) 4 (range 0-5). The median number of bariatric procedures performed was 40 for residents (range 0-148) and 220 during fellowships (range 5-306). Training in bariatric surgery differs considerably among centers. A structured program incorporating background knowledge, step-wise technical skills training, and life-long learning should enhance efficient training in bariatric teaching centers without affecting quality or patient safety.

  15. Implementation of full patient simulation training in surgical residency.

    Science.gov (United States)

    Fernandez, Gladys L; Lee, Patrick C; Page, David W; D'Amour, Elizabeth M; Wait, Richard B; Seymour, Neal E

    2010-01-01

    Simulated patient care has gained acceptance as a medical education tool but is underused in surgical training. To improve resident clinical management in critical situations relevant to the surgical patient, high-fidelity full patient simulation training was instituted at Baystate Medical Center in 2005 and developed during successive years. We define surgical patient simulation as clinical management performed in a high fidelity environment using a manikin simulator. This technique is intended to be specifically modeled experiential learning related to the knowledge, skills, and behaviors that are fundamental to patient care. We report 3 academic years' use of a patient simulation curriculum. Learners were PGY 1-3 residents; 26 simulated patient care experiences were developed based on (1) designation as a critical management problem that would otherwise be difficult to practice, (2) ability to represent the specific problem in simulation, (3) relevance to the American Board of Surgery (ABS) certifying examination, and/or (4) relevance to institutional quality or morbidity and mortality reports. Although training started in 2005, data are drawn from the period of systematic and mandatory training spanning from July 2006 to June 2009. Training occurred during 1-hour sessions using a computer-driven manikin simulator (METI, Sarasota, Florida). Educational content was provided either before or during presimulation briefing sessions. Scenario areas included shock states, trauma and critical care case management, preoperative processes, and postoperative conditions and complications. All sessions were followed by facilitated debriefing. Likert scale-based multi-item assessments of core competency in medical knowledge, patient care, diagnosis, management, communication, and professionalism were used to generate a performance score for each resident for each simulation (percentage of best possible score). Performance was compared across PGYs by repeated

  16. Developing a vision and strategic action plan for future community-based residency training.

    Science.gov (United States)

    Skelton, Jann B; Owen, James A

    2016-01-01

    The Community Pharmacy Residency Program (CPRP) Planning Committee convened to develop a vision and a strategic action plan for the advancement of community pharmacy residency training. Aligned with the profession's efforts to achieve provider status and expand access to care, the Future Vision and Action Plan for Community-based Residency Training will provide guidance, direction, and a strategic action plan for community-based residency training to ensure that the future needs of community-based pharmacist practitioners are met. National thought leaders, selected because of their leadership in pharmacy practice, academia, and residency training, served on the planning committee. The committee conducted a series of conference calls and an in-person strategic planning meeting held on January 13-14, 2015. Outcomes from the discussions were supplemented with related information from the literature. Results of a survey of CPRP directors and preceptors also informed the planning process. The vision and strategic action plan for community-based residency training is intended to advance training to meet the emerging needs of patients in communities that are served by the pharmacy profession. The group anticipated the advanced skills required of pharmacists serving as community-based pharmacist practitioners and the likely education, training and competencies required by future residency graduates in order to deliver these services. The vision reflects a transformation of community residency training, from CPRPs to community-based residency training, and embodies the concept that residency training should be primarily focused on training the individual pharmacist practitioner based on the needs of patients served within the community, and not on the physical location where pharmacy services are provided. The development of a vision statement, core values statements, and strategic action plan will provide support, guidance, and direction to the profession of pharmacy to

  17. A model of self-directed learning in internal medicine residency: a qualitative study using grounded theory.

    Science.gov (United States)

    Sawatsky, Adam P; Ratelle, John T; Bonnes, Sara L; Egginton, Jason S; Beckman, Thomas J

    2017-02-02

    Existing theories of self-directed learning (SDL) have emphasized the importance of process, personal, and contextual factors. Previous medical education research has largely focused on the process of SDL. We explored the experience with and perception of SDL among internal medicine residents to gain understanding of the personal and contextual factors of SDL in graduate medical education. Using a constructivist grounded theory approach, we conducted 7 focus group interviews with 46 internal medicine residents at an academic medical center. We processed the data by using open coding and writing analytic memos. Team members organized open codes to create axial codes, which were applied to all transcripts. Guided by a previous model of SDL, we developed a theoretical model that was revised through constant comparison with new data as they were collected, and we refined the theory until it had adequate explanatory power and was appropriately grounded in the experiences of residents. We developed a theoretical model of SDL to explain the process, personal, and contextual factors affecting SDL during residency training. The process of SDL began with a trigger that uncovered a knowledge gap. Residents progressed to formulating learning objectives, using resources, applying knowledge, and evaluating learning. Personal factors included motivations, individual characteristics, and the change in approach to SDL over time. Contextual factors included the need for external guidance, the influence of residency program structure and culture, and the presence of contextual barriers. We developed a theoretical model of SDL in medical education that can be used to promote and assess resident SDL through understanding the process, person, and context of SDL.

  18. [Medical ethics in residency training].

    Science.gov (United States)

    Civaner, Murat; Sarikaya, Ozlem; Balcioğlu, Harun

    2009-04-01

    Medical ethics education in residency training is one of the hot topics of continuous medical education debates. Its importance and necessity is constantly stressed in declarations and statements on national and international level. Parallel to the major structural changes in the organization and the finance model of health care system, patient-physician relationship, identity of physicianship, social perception and status of profession are changing. Besides, scientific developments and technological advancements create possibilities that never exists before, and bring new ethical dilemmas along with. To be able to transplant human organs has created two major problems for instance; procurement of organs in sufficient numbers, and allocating them to the patients in need by using some prioritizing criteria. All those new and challenging questions force the health care workers to find authentic and justifiable solutions while keeping the basic professional values. In that sense, proper medical ethics education in undergraduate and postgraduate term that would make physician-to-be's and student-physicians acquire the core professional values and skill to notice, analyze and develop justifiable solutions to ethical problems is paramount. This article aims to express the importance of medical ethics education in residency training, and to propose major topics and educational methods to be implemented into. To this aim, first, undergraduate medical education, physician's working conditions, the exam of selection for residency training, and educational environment were revised, and then, some topics and educational methods, which are oriented to educate physicians regarding the professional values that they should have, were proposed.

  19. Radiation oncology training in the United States: report from the Radiation Oncology Resident Training Working Group organized by the Society of Chairman of Academic Radiation Oncology Programs (SCAROP)

    International Nuclear Information System (INIS)

    1999-01-01

    Purpose: In response to the major changes occurring in healthcare, medical education, and cancer research, SCAROP addressed issues related to post-graduate education that could enhance existing programs and complement the present system. Methods and Materials: SCAROP brought together a Working Group with a broad range of representatives organized in subcommittees to address: training, curriculum, and model building. Results: The Working Group emphasized the importance of training physicians with the necessary clinical, scientific, and analytical skills, and the need to provide expert radiation oncology services to patients throughout the United States. Opportunities currently exist for graduates in academic medicine, although there may be limited time and financial resources available to support academic pursuits. Conclusions: In the face of diminishing resources for training and education and the increased scope of knowledge required, a number of models for resident training are considered that can provide flexibility to complement the present system. This report is intended to initiate dialogue among the organizations responsible for radiation oncology resident education so that resident training can continually evolve to meet the needs of cancer patients and take advantage of opportunities for progress through innovative cancer care and research

  20. Simulation-based education with mastery learning improves residents' lumbar puncture skills

    Science.gov (United States)

    Cohen, Elaine R.; Caprio, Timothy; McGaghie, William C.; Simuni, Tanya; Wayne, Diane B.

    2012-01-01

    Objective: To evaluate the effect of simulation-based mastery learning (SBML) on internal medicine residents' lumbar puncture (LP) skills, assess neurology residents' acquired LP skills from traditional clinical education, and compare the results of SBML to traditional clinical education. Methods: This study was a pretest-posttest design with a comparison group. Fifty-eight postgraduate year (PGY) 1 internal medicine residents received an SBML intervention in LP. Residents completed a baseline skill assessment (pretest) using a 21-item LP checklist. After a 3-hour session featuring deliberate practice and feedback, residents completed a posttest and were expected to meet or exceed a minimum passing score (MPS) set by an expert panel. Simulator-trained residents' pretest and posttest scores were compared to assess the impact of the intervention. Thirty-six PGY2, 3, and 4 neurology residents from 3 medical centers completed the same simulated LP assessment without SBML. SBML posttest scores were compared to neurology residents' baseline scores. Results: PGY1 internal medicine residents improved from a mean of 46.3% to 95.7% after SBML (p < 0.001) and all met the MPS at final posttest. The performance of traditionally trained neurology residents was significantly lower than simulator-trained residents (mean 65.4%, p < 0.001) and only 6% met the MPS. Conclusions: Residents who completed SBML showed significant improvement in LP procedural skills. Few neurology residents were competent to perform a simulated LP despite clinical experience with the procedure. PMID:22675080

  1. Are Nursing Students Appropriate Partners for the Interdisciplinary Training of Surgery Residents?

    Science.gov (United States)

    Stefanidis, Dimitrios; Ingram, Katherine M; Williams, Kristy H; Bencken, Crystal L; Swiderski, Dawn

    2015-01-01

    Interdisciplinary team training in a simulation center recreates clinical team interactions and holds promise in improving teamwork of clinicians by breaking down educational silos. The objective of our study was to assess the appropriateness of interdisciplinary training with general surgery residents and nursing students. Over 2 consecutive academic years (2012-2013 and 2013-2014), general surgery residents participated in interdisciplinary team-training simulation-based sessions with senior nursing students. Scenario objectives included demonstration of appropriate teamwork and communication, and clinical decision making; sessions incorporated interdisciplinary debriefing of the scenarios. Participants were asked to assess their team-training experience and the appropriateness of their team-training partner. Responses were compared. A total of 16 team-training sessions were conducted during the study period. Overall, 12 surgery residents (67%) and 44 nursing students (63%) who had participated in at least 1 session responded to the survey. Although both residents and nursing students indicated that the knowledge and team skills acquired during these sessions were useful to them in clinical practice (73% vs 86%, respectively; p = not significant), residents rated their educational value lower (3.3 vs 4.3 on a 5-point scale, respectively; p training partners whereas 100% residents preferred practicing nurses and 0% with nursing students owing to their limited clinical experience. Interdisciplinary team training and debriefing of surgery residents with nursing students is feasible and highly valued by nursing students. Nevertheless, our experience indicates that residents do not prefer nursing students as team-training partners owing to their limited clinical experience and would rather train with experienced nurses. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  2. Features of residency training and psychological distress among ...

    African Journals Online (AJOL)

    Features of residency training and psychological distress among residents in a Nigerian teaching hospital. O Esan, A Adeoye, P Onakoya, O Opeodu, K Owonikoko, D Olulana, M Bello, A Adeyemo, L Onigbogi, O Idowu, T Akute ...

  3. Training Pediatric Residents to Provide Smoking Cessation Counseling to Parents

    Directory of Open Access Journals (Sweden)

    Rebecca L. Collins

    2005-01-01

    Full Text Available The objective was to assess the effectiveness of a smoking cessation educational program on pediatric residents' counseling. Residents were randomly selected to receive the intervention. Residents who were trained were compared to untrained residents. Self-reported surveys and patient chart reviews were used. Measures included changes in self-reported knowledge, attitudes and behaviors of residents, and differences in chart documentation and caretaker-reported physician counseling behaviors. The intervention was multidimensional including a didactic presentation, a problem-solving session, clinic reminders, and provision of patient education materials. Results showed that residents who were trained were more likely to ask about tobacco use in their patients' households. They were also more likely to advise caretakers to cut down on or to quit smoking, to help set a quit date, and to follow up on the advice given at a subsequent visit. Trained residents were more likely to record a history of passive tobacco exposure in the medical record. These residents also reported improved confidence in their counseling skills and documented that they had done such counseling more often than did untrained residents. Caretakers of pediatric patients who smoke seen by intervention residents were more likely to report that they had received tobacco counseling. Following this intervention, pediatric residents significantly improved their behaviors, attitudes, and confidence in providing smoking cessation counseling to parents of their pediatric patients.

  4. Challenges of interprofessional team training: a qualitative analysis of residents' perceptions.

    Science.gov (United States)

    van Schaik, Sandrijn; Plant, Jennifer; O'Brien, Bridget

    2015-01-01

    Simulation-based interprofessional team training is thought to improve patient care. Participating teams often consist of both experienced providers and trainees, which likely impacts team dynamics, particularly when a resident leads the team. Although similar team composition is found in real-life, debriefing after simulations puts a spotlight on team interactions and in particular on residents in the role of team leader. The goal of the current study was to explore residents' perceptions of simulation-based interprofessional team training. This was a secondary analysis of a study of residents in the pediatric residency training program at the University of California, San Francisco (United States) leading interprofessional teams in simulated resuscitations, followed by facilitated debriefing. Residents participated in individual, semi-structured, audio-recorded interviews within one month of the simulation. The original study aimed to examine residents' self-assessment of leadership skills, and during analysis we encountered numerous comments regarding the interprofessional nature of the simulation training. We therefore performed a secondary analysis of the interview transcripts. We followed an iterative process to create a coding scheme, and used interprofessional learning and practice as sensitizing concepts to extract relevant themes. 16 residents participated in the study. Residents felt that simulated resuscitations were helpful but anxiety provoking, largely due to interprofessional dynamics. They embraced the interprofessional training opportunity and appreciated hearing other healthcare providers' perspectives, but questioned the value of interprofessional debriefing. They identified the need to maintain positive relationships with colleagues in light of the teams' complex hierarchy as a barrier to candid feedback. Pediatric residents in our study appreciated the opportunity to participate in interprofessional team training but were conflicted about the

  5. Teaching Emotional Intelligence: A Control Group Study of a Brief Educational Intervention for Emergency Medicine Residents

    Directory of Open Access Journals (Sweden)

    Diane L. Gorgas

    2015-11-01

    Full Text Available Introduction: Emotional Intelligence (EI is defined as an ability to perceive another’s emotional state combined with an ability to modify one’s own. Physicians with this ability are at a distinct advantage, both in fostering teams and in making sound decisions. Studies have shown that higher physician EI’s are associated with lower incidence of burn-out, longer careers, more positive patient-physician interactions, increased empathy, and improved communication skills. We explored the potential for EI to be learned as a skill (as opposed to being an innate ability through a brief educational intervention with emergency medicine (EM residents. Methods: This study was conducted at a large urban EM residency program. Residents were randomized to either EI intervention or control groups. The intervention was a two-hour session focused on improving the skill of social perspective taking (SPT, a skill related to social awareness. Due to time limitations, we used a 10-item sample of the Hay 360 Emotional Competence Inventory to measure EI at three time points for the training group: before (pre and after (post training, and at six-months post training (follow up; and at two time points for the control group: pre- and follow up. The preliminary analysis was a four-way analysis of variance with one repeated measure: Group x Gender x Program Year over Time. We also completed post-hoc tests. Results: Thirty-three EM residents participated in the study (33 of 36, 92%, 19 in the EI intervention group and 14 in the control group. We found a significant interaction effect between Group and Time (p<0.05. Post-hoc tests revealed a significant increase in EI scores from Time 1 to 3 for the EI intervention group (62.6% to 74.2%, but no statistical change was observed for the controls (66.8% to 66.1%, p=0.77. We observed no main effects involving gender or level of training. Conclusion: Our brief EI training showed a delayed but statistically significant

  6. Cricothyroidotomy In Situ Simulation Curriculum (CRIC Study): Training Residents for Rare Procedures.

    Science.gov (United States)

    Petrosoniak, Andrew; Ryzynski, Agnes; Lebovic, Gerald; Woolfrey, Karen

    2017-04-01

    Technical skill acquisition for rare procedures can be challenging given the few real-life training opportunities. In situ simulation (ISS), a training technique that takes place in the actual workplace, is a promising method to promote environmental fidelity for rare procedures. This study evaluated a simulation-based technical skill curriculum for cricothyroidotomy using deliberate practice, followed by an ISS evaluation session. Twenty emergency medicine residents participated in a two-part curriculum to improve cricothryoidotomy performance. A pretest established participant baseline technical skill. The training session consisted of two parts, didactic teaching followed by deliberate practice using a task-training manikin. A posttest consisted of an unannounced, high-fidelity ISS, during an emergency department shift. The primary outcome was the mean performance time between the pretest and posttest sessions. Skill performance was also evaluated using a checklist scale and global rating scale. Cricothyroidotomy performance time improved significantly from pretest to posttest sessions (mean difference, 59 seconds; P training session consisting of didactic learning and deliberate practice, improved cricothyroidotomy skill performance was observed during an unannounced ISS in the emergency department. The integration of ISS in cricothyroidotomy training represents a promising approach; however, further study is needed to establish its role.

  7. Residents' and attendings' perceptions of a night float system in an internal medicine program in Canada.

    Science.gov (United States)

    Saxena, Anurag; Desanghere, Loni; Skomro, Robert P; Wilson, Thomas W

    2015-01-01

    The Night Float system (NFS) is often used in residency training programs to meet work hour regulations. The purpose of this study was to examine resident and attendings' perceptions of the NFS on issues of resident learning, well-being, work, non-educational activities and the health care system (patient safety and quality of care, inter-professional teams, workload on attendings and costs of on-call coverage). A survey questionnaire with closed and open-ended questions (26 residents and eight attendings in an Internal Medicine program), informal discussions with the program and moonlighting and financial data were collected. The main findings included, (i) an overall congruency in opinions between resident and attendings across all mean comparisons, (ii) perceptions of improvement for most aspects of resident well-being (e.g. stress, fatigue) and work environment (e.g. supervision, support), (iii) a neutral effect on the resident learning environment, except resident opinions on an increase in opportunities for learning, (iv) perceptions of improved patient safety and quality of care despite worsened continuity of care, and (v) no increases in work-load on attendings or the health care system (cost-neutral call coverage). Patient safety, handovers and increased utilization of moonlighting opportunities need further exploration.

  8. Effect of Educational Debt on Emergency Medicine Residents: A Qualitative Study Using Individual Interviews.

    Science.gov (United States)

    Young, Timothy P; Brown, Madison M; Reibling, Ellen T; Ghassemzadeh, Sassan; Gordon, Dawn M; Phan, Tammy H; Thomas, Tamara L; Brown, Lance

    2016-10-01

    In 2001, less than 20% of emergency medicine residents had more than $150,000 of educational debt. Our emergency medicine residents anecdotally reported much larger debt loads. Surveys have reported that debt affects career and life choices. Qualitative approaches are well suited to explore how and why such complex phenomena occur. We aim to gain a better understanding of how our emergency medicine residents experience debt. We conducted individual semistructured interviews with emergency medicine residents. We collected self-reported data related to educational debt and asked open-ended questions about debt influence on career choices, personal life, future plans, and financial decisions. We undertook a structured thematic analysis using a qualitative approach based in the grounded theory method. Median educational debt was $212,000. Six themes emerged from our analysis: (1) debt influenced career and life decisions by altering priorities; (2) residents experienced debt as a persistent source of background stress and felt powerless to change it; (3) residents made use of various techniques to negotiate debt in order to focus on day-to-day work; (4) personal debt philosophy, based on individual values and obtained from family, shaped how debt affected each individual; (5) debt had a normative effect and was acculturated in residency; and (6) residents reported a wide range of financial knowledge, but recognized its importance to career success. Our emergency medicine residents' debt experience is complex and involves multiple dimensions. Given our current understanding, simple solutions are unlikely to be effective in adequately addressing this issue. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  9. Education research: neurology training reassessed. The 2011 American Academy of Neurology Resident Survey results.

    Science.gov (United States)

    Johnson, Nicholas E; Maas, Matthew B; Coleman, Mary; Jozefowicz, Ralph; Engstrom, John

    2012-10-23

    To assess the strengths and weaknesses of neurology resident education using survey methodology. A 27-question survey was sent to all neurology residents completing residency training in the United States in 2011. Of eligible respondents, 49.8% of residents returned the survey. Most residents believed previously instituted duty hour restrictions had a positive impact on resident quality of life without impacting patient care. Most residents rated their faculty and clinical didactics favorably. However, many residents reported suboptimal preparation in basic neuroscience and practice management issues. Most residents (71%) noted that the Residency In-service Training Examination (RITE) assisted in self-study. A minority of residents (14%) reported that the RITE scores were used for reasons other than self-study. The vast majority (86%) of residents will enter fellowship training following residency and were satisfied with the fellowship offers they received. Graduating residents had largely favorable neurology training experiences. Several common deficiencies include education in basic neuroscience and clinical practice management. Importantly, prior changes to duty hours did not negatively affect the resident perception of neurology residency training.

  10. Self-Reported Emergency Medicine Residency Applicant Attitudes Towards a Procedural Cadaver Laboratory Curriculum

    Directory of Open Access Journals (Sweden)

    Hoffman, Lance

    2008-08-01

    Full Text Available OBJECTIVE: Residency applicants consider a variety of factors when ranking emergency medicine (EM programs for their NRMP match list. A human cadaver emergency procedure lab curriculum is uncommon. We hypothesized that the presence this curriculum would positively impact the ranking of an EM residency program.METHODS: The EM residency at Nebraska Medical Center is an urban, university-based program with a PGY I-III format. Residency applicants during the interview for a position in the PGY I class of 2006 were surveyed by three weekly electronic mailings. The survey was distributed in March 2006 after the final NRMP match results were released. The survey explored learner preferences and methodological commonality of models of emergency procedural training, as well as the impact of a procedural cadaver lab curriculum on residency ranking. ANOVA of ranks was used to compare responses to ranking questions.RESULTS: Of the 73 potential subjects, 54 (74% completed the survey. Respondents ranked methods of procedural instruction from 1 (most preferred or most common technique to 4 (least preferred or least common technique. Response averages and 95% confidence intervals for the preferred means of learning a new procedure are as follows: textbook (3.69; 3.51-3.87, mannequin (2.83; 2.64-3.02, human cadaver (1.93; 1.72-2.14, and living patient (1.56; 1.33-1.79. Response averages for the commonality of means used to teach a new procedure are as follows: human cadaver (3.63; 3.46-3.80, mannequin (2.70; 2.50-2.90, living patient (2.09; 1.85-2.33, and textbook (1.57; 1.32-1.82. When asked if the University of Nebraska Medical Center residency ranked higher in the individual's match list because of its procedural cadaver lab, 14.8% strongly disagreed, 14.8% disagreed, 40.7% were neutral, 14.8% agreed, and 14.8% strongly agreed.CONCLUSION: We conclude that, although cadaveric procedural training is viewed by senior medical student learners as a desirable means

  11. Geriatrics education is associated with positive attitudes toward older people in internal medicine residents: a multicenter study.

    Science.gov (United States)

    Tufan, Fatih; Yuruyen, Mehmet; Kizilarslanoglu, Muhammet Cemal; Akpinar, Timur; Emiksiye, Sirhan; Yesil, Yusuf; Ozturk, Zeynel Abidin; Bozbulut, Utku Burak; Bolayir, Basak; Tasar, Pinar Tosun; Yavuzer, Hakan; Sahin, Sevnaz; Ulger, Zekeriya; Ozturk, Gulistan Bahat; Halil, Meltem; Akcicek, Fehmi; Doventas, Alper; Kepekci, Yalcin; Ince, Nurhan; Karan, Mehmet Akif

    2015-01-01

    The number of older people is growing fast in Turkey. In this context, internal medicine residents and specialists contact older people more frequently. Thus, healthcare providers' knowledge and attitudes toward older people is becoming more important. Studies that specifically investigate internal medicine residents' attitudes toward the elderly are scarce. We aimed to investigate the attitudes of internal medicine residents toward older people. This cross-sectional multicenter study was undertaken in the internal medicine clinics of six university state hospitals that provide education in geriatric care. All internal medicine residents working in these hospitals were invited to participate in this questionnaire study between March 2013 and December 2013. We recorded the participants' age, sex, duration of internal medicine residency, existence of relatives older than 65 years, history of geriatrics course in medical school, geriatrics rotation in internal medicine residency, and nursing home visits. A total of 274 (82.3%) of the residents participated in this study, and 83.6% of them had positive attitudes toward older people. A geriatrics rotation during internal medicine residency was the only independent factor associated with positive attitudes toward the elderly in this multivariate analysis. A geriatrics course during medical school was associated with positive attitudes in the univariate analysis, but only tended to be so in the multivariate analysis. Geriatrics rotation during internal medicine residency was independently associated with positive attitudes toward older people. Generalization of geriatrics education in developing countries may translate into a better understanding and improved care for older patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  12. Association between periodontal diseases and systemic illnesses: A survey among internal medicine residents in Nigeria.

    Science.gov (United States)

    Umeizudike, Kehinde A; Iwuala, Sandra O; Ozoh, Obianuju B; Ayanbadejo, Patricia O; Fasanmade, Olufemi A

    2016-01-01

    To assess internal medicine residents' knowledge of associations between periodontal disease and systemic illnesses, and attitudes toward patients' periodontal health. A cross-sectional survey using a self-administered questionnaire was conducted among internal medicine residents attending the Faculty of Internal Medicine 2014 Update Course organized by the National Postgraduate Medical College of Nigeria. Participants came from all over the country. Data on respondents' demographic characteristics, periodontal disease knowledge, knowledge of associations between periodontal disease and systemic illnesses, and attitudes toward patients' periodontal health were collected. Data were analyzed using Epi INFO software. The Pearson chi square test was used to measure significant association between categorical variables such as the knowledge of periodontal disease and gender, age group and designation of the participants (p ⩽ 0.05). Of 150 questionnaires distributed, 123 were returned (82% response rate); 109 questionnaires were completed properly and included in the analysis. The most common source of residents' information on oral health was television (59.4%). Only 11.2% of respondents were aware that gingival bleeding was the earliest sign of periodontal disease. Respondents correctly identified periodontal disease as a risk factor for coronary heart disease (45.9%), stroke (43.5%), hospital-acquired pneumonia (53.2%), diabetes mellitus (13.8%), and preterm birth (11%). Increased age (p = 0.032) and male gender (p = 0.022) were associated significantly with knowledge of periodontal disease as a risk factor for stroke. Higher designation (p = 0.002) and longer duration in residency training (p = 0.004) were associated significantly with knowledge of periodontal disease as risk factor for peripheral arterial disease. The majority (90.9%) of respondents had positive attitudes toward the referral of their patients for regular periodontal care. Knowledge of

  13. CNA Training Requirements and Resident Care Outcomes in Nursing Homes.

    Science.gov (United States)

    Trinkoff, Alison M; Storr, Carla L; Lerner, Nancy B; Yang, Bo Kyum; Han, Kihye

    2017-06-01

    To examine the relationship between certified nursing assistant (CNA) training requirements and resident outcomes in U.S. nursing homes (NHs). The number and type of training hours vary by state since many U.S. states have chosen to require additional hours over the federal minimums, presumably to keep pace with the increasing complexity of care. Yet little is known about the impact of the type and amount of training CNAs are required to have on resident outcomes. Compiled data on 2010 state regulatory requirements for CNA training (clinical, total initial training, in-service, ratio of clinical to didactic hours) were linked to 2010 resident outcomes data from 15,508 NHs. Outcomes included the following NH Compare Quality Indicators (QIs) (Minimum Data Set 3.0): pain, antipsychotic use, falls with injury, depression, weight loss and pressure ulcers. Facility-level QIs were regressed on training indicators using generalized linear models with the Huber-White correction, to account for clustering of NHs within states. Models were stratified by facility size and adjusted for case-mix, ownership status, percentage of Medicaid-certified beds and urban-rural status. A higher ratio of clinical to didactic hours was related to better resident outcomes. NHs in states requiring clinical training hours above federal minimums (i.e., >16hr) had significantly lower odds of adverse outcomes, particularly pain falls with injury, and depression. Total and in-service training hours also were related to outcomes. Additional training providing clinical experiences may aid in identifying residents at risk. This study provides empirical evidence supporting the importance of increased requirements for CNA training to improve quality of care. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  14. An "education for life" requirement to promote lifelong learning in an internal medicine residency program.

    Science.gov (United States)

    Panda, Mukta; Desbiens, Norman A

    2010-12-01

    Lifelong learning is an integral component of practice-based learning and improvement. Physicians need to be lifelong learners to provide timely, efficient, and state-of-the-art patient care in an environment where knowledge, technology, and social requirements are rapidly changing. To assess graduates' self-reported perception of the usefulness of a residency program requirement to submit a narrative report describing their planned educational modalities for their future continued medical learning ("Education for Life" requirement), and to compare the modalities residents intended to use with their reported educational activities. Data was compiled from the Education for Life reports submitted by internal medicine residents at the University of Tennessee College of Medicine Chattanooga from 1998 to 2000, and from a survey sent to the same 27 graduates 2 to 4 years later from 2000 to 2004. Twenty-four surveys (89%) were returned. Of the responding graduates, 58% (14/24) found the Education for Life requirement useful for their future continued medical learning. Graduates intended to keep up with a mean of 3.4 educational modalities, and they reported keeping up with 4.2. In a multivariable analysis, the number of modalities graduates used was significantly associated with the number they had planned to use before graduation (P  =  .04) but not with their career choice of subspecialization. The majority of residents found the Education for Life requirement useful for their future continued medical learning. Graduates, regardless of specialty, reported using more modalities for continuing their medical education than they thought they would as residents. Considering lifelong learning early in training and then requiring residents to identify ways to practice lifelong learning as a requirement for graduation may be dispositive.

  15. Swiss residents' arguments for and against a career in medicine.

    Science.gov (United States)

    Buddeberg-Fischer, Barbara; Dietz, Claudia; Klaghofer, Richard; Buddeberg, Claus

    2006-08-14

    In some Western countries, the medical profession is continuously losing prestige, doctors are claiming of high demands, low rewards, and difficult structural working conditions. This study aimed to investigate the arguments given by Swiss residents for and against a career in medicine. As part of a prospective cohort study of Swiss medical school graduates on career development, 567 fourth-year residents were asked to answer the free-response item of what arguments there still were in favour of or against a career in medicine. They also indicated whether they would choose the medical profession all over again (yes/no). The statements were transcribed, content categories inductively formulated, and their descriptions written down in a code manual. Arguments were encoded according to the code manual and assigned to eight content categories (Mayring's content analysis). Frequency distributions were given for categories and tested with Chi2-tests for differences in gender, speciality fields, and whether or not the respondent would again choose a career in medicine. The 567 participants made 1,640 statements in favour of and 1,703 statements against a career in medicine. The content analysis of the residents' answers yielded eight categories with arguments both for and against a career in medicine. Of all "statements for" responses, 70% fell into the two top-ranking categories of Personal experiences in day-to-day working life (41.2%) and Interpersonal experiences in professional relationships (28.8%). The top-ranking category of the "statements against" arguments was General work-related structural conditions (32%), followed by Social prestige and health-policy aspects (21%). Main arguments in favour of a career in medicine were interdisciplinary challenge, combination of basic sciences and interpersonal concerns, helping suffering people, guarantee of a secure job; arguments against comprised high workload, time pressure, emotional stress, poorly structured

  16. Swiss residents' arguments for and against a career in medicine

    Science.gov (United States)

    Buddeberg-Fischer, Barbara; Dietz, Claudia; Klaghofer, Richard; Buddeberg, Claus

    2006-01-01

    Background In some Western countries, the medical profession is continuously losing prestige, doctors are claiming of high demands, low rewards, and difficult structural working conditions. This study aimed to investigate the arguments given by Swiss residents for and against a career in medicine. Methods As part of a prospective cohort study of Swiss medical school graduates on career development, 567 fourth-year residents were asked to answer the free-response item of what arguments there still were in favour of or against a career in medicine. They also indicated whether they would choose the medical profession all over again (yes/no). The statements were transcribed, content categories inductively formulated, and their descriptions written down in a code manual. Arguments were encoded according to the code manual and assigned to eight content categories (Mayring's content analysis). Frequency distributions were given for categories and tested with Chi2-tests for differences in gender, speciality fields, and whether or not the respondent would again choose a career in medicine. Results The 567 participants made 1,640 statements in favour of and 1,703 statements against a career in medicine. The content analysis of the residents' answers yielded eight categories with arguments both for and against a career in medicine. Of all "statements for" responses, 70% fell into the two top-ranking categories of Personal experiences in day-to-day working life (41.2%) and Interpersonal experiences in professional relationships (28.8%). The top-ranking category of the "statements against" arguments was General work-related structural conditions (32%), followed by Social prestige and health-policy aspects (21%). Main arguments in favour of a career in medicine were interdisciplinary challenge, combination of basic sciences and interpersonal concerns, helping suffering people, guarantee of a secure job; arguments against comprised high workload, time pressure, emotional stress

  17. The impact of a medical procedure service on patient safety, procedure quality and resident training opportunities.

    Science.gov (United States)

    Tukey, Melissa H; Wiener, Renda Soylemez

    2014-03-01

    At some academic hospitals, medical procedure services are being developed to provide supervision for residents performing bedside procedures in hopes of improving patient safety and resident education. There is limited knowledge of the impact of such services on procedural complication rates and resident procedural training opportunities. To determine the impact of a medical procedure service (MPS) on patient safety and resident procedural training opportunities. Retrospective cohort analysis comparing characteristics and outcomes of procedures performed by the MPS versus the primary medical service. Consecutive adults admitted to internal medicine services at a large academic hospital who underwent a bedside medical procedure (central venous catheterization, thoracentesis, paracentesis, lumbar puncture) between 1 July 2010 and 31 December 2011. The primary outcome was a composite rate of major complications. Secondary outcomes included resident participation in bedside procedures and use of "best practice" safety process measures. We evaluated 1,707 bedside procedures (548 by the MPS, 1,159 by the primary services). There were no differences in the composite rate of major complications (1.6 % vs. 1.9 %, p = 0.71) or resident participation in bedside procedures (57.0 % vs. 54.3 %, p = 0.31) between the MPS and the primary services. Procedures performed by the MPS were more likely to be successfully completed (95.8 % vs. 92.8 %, p = 0.02) and to use best practice safety process measures, including use of ultrasound guidance when appropriate (96.8 % vs. 90.0 %, p = 0.0004), avoidance of femoral venous catheterization (89.5 vs. 82.7 %, p = 0.02) and involvement of attending physicians (99.3 % vs. 57.0 %, p < 0.0001). Although use of a MPS did not significantly affect the rate of major complications or resident opportunities for training in bedside procedures, it was associated with increased use of best practice safety process measures.

  18. Residents' and preceptors' perceptions of the use of the iPad for clinical teaching in a family medicine residency program.

    Science.gov (United States)

    Archibald, Douglas; Macdonald, Colla J; Plante, Judith; Hogue, Rebecca J; Fiallos, Javier

    2014-08-20

    As Family Medicine programs across Canada are transitioning into a competency-based curriculum, medical students and clinical teachers are increasingly incorporating tablet computers in their work and educational activities. The purpose of this pilot study was to identify how preceptors and residents use tablet computers to implement and adopt a new family medicine curriculum and to evaluate how they access applications (apps) through their tablet in an effort to support and enhance effective teaching and learning. Residents and preceptors (n = 25) from the Family Medicine program working at the Pembroke Regional Hospital in Ontario, Canada, were given iPads and training on how to use the device in clinical teaching and learning activities and how to access the online curriculum. Data regarding the use and perceived contribution of the iPads were collected through surveys and focus groups. This mixed methods research used analysis of survey responses to support the selection of questions for focus groups. Reported results were categorized into: curriculum and assessment; ease of use; portability; apps and resources; and perceptions about the use of the iPad in teaching/learning setting. Most participants agreed on the importance of accessing curriculum resources through the iPad but recognized that these required enhancements to facilitate use. The iPad was considered to be more useful for activities involving output of information than for input. Participants' responses regarding the ease of use of mobile technology were heterogeneous due to the diversity of computer proficiency across users. Residents had a slightly more favorable opinion regarding the iPad's contribution to teaching/learning compared to preceptors. iPad's interface should be fully enhanced to allow easy access to online curriculum and its built-in resources. The differences in computer proficiency level among users should be reduced by sharing knowledge through workshops led by more skillful i

  19. [The specialty program as a training tool: an individual training plan for each resident].

    Science.gov (United States)

    Rodríguez González, R; Capilla Cabezuelo, E

    2010-01-01

    The official training program for the specialty "Diagnostic Imaging" establishes minimum learning objectives that must be fulfilled. Each accredited teaching unit is responsible for designing and carrying out a curriculum to ensure that these objectives are met, and this approach permits a degree of flexibility. Various aspects must be considered in the individual training plans for each resident: the rotation scheme according to the way the department is organized, plans for recovering missed material or reinforcing weak points, optional rotations, increasing degrees of responsibility as skills are acquired during training, and accommodating special needs of handicapped persons. Nevertheless, the individual plan must be fitted to the established curriculum and guarantee that the content of the official program is covered and that the objectives stipulated therein are met. Furthermore, the methods of teaching must be adapted to the individual characteristics of the residents, and this is the most important aspect of the individualization of training. To this end, it is fundamental for residents to take on an active role in their training, guided by their tutor and with the participation of all the radiologists in the department including the other residents, all of whom should act as teachers. Copyright © 2010 SERAM. Published by Elsevier Espana. All rights reserved.

  20. Emergency medicine residents' beliefs about contributing to an online collaborative slideshow.

    Science.gov (United States)

    Archambault, Patrick M; Thanh, Jasmine; Blouin, Danielle; Gagnon, Susie; Poitras, Julien; Fountain, Renée-Marie; Fleet, Richard; Bilodeau, Andrea; van de Belt, Tom H; Légaré, France

    2015-07-01

    Collaborative writing applications (CWAs), such as the Google DocsTM platform, can improve skill acquisition, knowledge retention, and collaboration in medical education. Using CWAs to support the training of residents offers many advantages, but stimulating them to contribute remains challenging. The purpose of this study was to identify emergency medicine (EM) residents' beliefs about their intention to contribute summaries of landmark articles to a Google DocsTM slideshow while studying for their Royal College of Physicians and Surgeons of Canada (RCPSC) certification exam. Using the Theory of Planned Behavior, the authors interviewed graduating RCPSC EM residents about contributing to a slideshow. Residents were asked about behavioral beliefs (advantages/disadvantages), normative beliefs (positive/negative referents), and control beliefs (barriers/facilitators). Two reviewers independently performed qualitative content analysis of interview transcripts to identify salient beliefs in relation to the defined behaviors. Of 150 eligible EM residents, 25 participated. The main reported advantage of contributing to the online slideshow was learning consolidation (n=15); the main reported disadvantage was information overload (n=3). The most frequently reported favorable referents were graduating EM residents writing the certification exam (n=16). Few participants (n=3) perceived any negative referents. The most frequently reported facilitator was peer-reviewed high-quality scientific information (n=9); and the most frequently reported barrier was time constraints (n=22). Salient beliefs exist regarding EM residents' intention to contribute content to an online collaborative writing project using a Google DocsTM slideshow. Overall, participants perceived more advantages than disadvantages to contributing and believed that this initiative would receive wide support. However, participants reported several barriers that need to be addressed to increase contributions. Our

  1. Developing an integrated evidence-based medicine curriculum for family medicine residency at the University of Alberta.

    Science.gov (United States)

    Allan, G Michael; Korownyk, Christina; Tan, Amy; Hindle, Hugh; Kung, Lina; Manca, Donna

    2008-06-01

    There is general consensus in the academic community that evidence-based medicine (EBM) teaching is essential. Unfortunately, many postgraduate programs have significant weakness in their EBM programs. The Family Medicine Residency committee at the University of Alberta felt their EBM curriculum would benefit from critical review and revision. An EBM Curriculum Committee was created to evaluate previous components and develop new strategies as needed. Input from stakeholders including faculty and residents was sought, and evidence regarding the teaching and practical application of EBM was gathered. The committee drafted goals and objectives, the primary of which were to assist residents to (1) become competent self-directed, lifelong learners with skills to effectively and efficiently keep up to date, and 2) develop EBM skills to solve problems encountered in daily practice. New curriculum components, each evidence based, were introduced in 2005 and include a family medicine EBM workshop to establish basic EBM knowledge; a Web-based Family Medicine Desktop promoting easier access to evidence-based Internet resources; a brief evidence-based assessment of the research project enhancing integration of EBM into daily practice; and a journal club to support peer learning and growth of rapid appraisal skills. Issues including time use, costs, and change management are discussed. Ongoing evaluation of the curriculum and its components is a principal factor of the design, allowing critical review and adaptation of the curriculum. The first two years of the curriculum have yielded positive feedback from faculty and statistically significant improvement in multiple areas of residents' opinions of the curriculum and comfort with evidence-based practice.

  2. Sleep behaviors and attitudes among internal medicine housestaff in a U.S. university-based residency program.

    Science.gov (United States)

    Rosen, Ilene M; Bellini, Lisa M; Shea, Judy A

    2004-05-01

    Physicians-in-training are susceptible to fatigue given their prolonged duty hours. Sleep deprivation has been shown to alter perceptions of sleepiness and performance. This study examined the state of sleepiness and attitudes about sleep and performance of work- and non-work-related tasks among incoming and current housestaff; and how rotation, call cycle, and call status are related to acute and chronic sleep deprivation and perceptions of sleepiness. A survey instrument was administered in June 2001 to 53 incoming interns and 79 current housestaff at the University Pennsylvania School of Medicine, a university-based internal medicine residency program. All 132 participants (100%) completed the instrument. Acute sleep deprivation was experienced by 34% of the current housestaff and 64% of current housestaff were chronically sleep deprived. Current housestaff admitted to the possibility of dozing while performing various work-related tasks such as writing notes in charts (69%), reviewing medication lists (61%), interpreting labs (51%), and writing orders (46%). At least half of all respondents felt their patients received good care despite residents' sleepiness and as many believed sleep deprivation was a necessary part of training. Nearly half (48%) of current housestaff rotating on a ward service reported acute sleep deprivation, as did 81% of those who were postcall. Over two-thirds of the housestaff on wards and in the ICU reported chronic sleep deprivation. Subjective sleepiness did not vary much across rotations, call cycle, and call status. Chronic and acute sleep deprivation contribute to residents' fatigue. Education could be targeted at attitudes. Further investigation of factors contributing to chronic sleep deprivation in this population is warranted.

  3. Toward shared decision making: using the OPTION scale to analyze resident-patient consultations in family medicine

    NARCIS (Netherlands)

    Pellerin, M.A.; Elwyn, G.; Rousseau, M.; Stacey, D.; Robitaille, H.; Legare, F.

    2011-01-01

    PURPOSE: Do residents in family medicine practice share decision making with patients during consultations? This study used a validated scale to score family medicine residents' shared decision-making (SDM) skills in primary care consultations and to determine whether residents' demographic

  4. Top five craniofacial techniques for training in plastic surgery residency.

    Science.gov (United States)

    Fan, Kenneth; Kawamoto, Henry K; McCarthy, Joseph G; Bartlett, Scott P; Matthews, David C; Wolfe, S Anthony; Tanna, Neil; Vu, Minh-Thien; Bradley, James P

    2012-03-01

    Despite increasing specialization of craniofacial surgery, certain craniofacial techniques are widely applicable. The authors identified five such craniofacial techniques and queried American Society of Plastic Surgeons members and plastic surgery program directors regarding their comfort level with the procedures and their opinion on resident training for these selected procedures. First, a select group of senior craniofacial surgeons discussed and agreed on the top five procedures. Second, active American Society of Plastic Surgeons were surveyed regarding their opinion on training and their comfort level with each procedure. Third, plastic surgery residency program directors were studied to see which of the top five procedures are taught as part of the plastic surgery residency curriculum. The top five widely applicable craniofacial procedures are technically described and include the following: (1) cranial or iliac bone graft for nasal reconstruction, (2) perialar rim bone graft, (3) lateral canthopexy, (4) osseous genioplasty, and (5) bone graft harvest for orbital floor defects. For practicing plastic surgeons, comfort level in all procedures increased with advancing years in practice (except those with 75 percent), especially those with craniofacial fellowship training, felt competent in all procedures except osseous genioplasty (53 percent). Plastic surgery program directors agreed that all top five procedures should be mastered by graduation. Although program directors felt that all five selected craniofacial procedures should be taught and mastered during residency training, plastic surgeons without craniofacial fellowship training were less comfortable with the techniques. Residency training goals should include competence in core craniofacial techniques.

  5. Resident away rotations allow adaptive neurosurgical training.

    Science.gov (United States)

    Gephart, Melanie Hayden; Derstine, Pamela; Oyesiku, Nelson M; Grady, M Sean; Burchiel, Kim; Batjer, H Hunt; Popp, A John; Barbaro, Nicholas M

    2015-04-01

    Subspecialization of physicians and regional centers concentrate the volume of certain rare cases into fewer hospitals. Consequently, the primary institution of a neurological surgery training program may not have sufficient case volume to meet the current Residency Review Committee case minimum requirements in some areas. To ensure the competency of graduating residents through a comprehensive neurosurgical education, programs may need for residents to travel to outside institutions for exposure to cases that are either less common or more regionally focused. We sought to evaluate off-site rotations to better understand the changing demographics and needs of resident education. This would also allow prospective monitoring of modifications to the neurosurgery training landscape. We completed a survey of neurosurgery program directors and query of data from the Accreditation Council of Graduate Medical Education to characterize the current use of away rotations in neurosurgical education of residents. We found that 20% of programs have mandatory away rotations, most commonly for exposure to pediatric, functional, peripheral nerve, or trauma cases. Most of these rotations are done during postgraduate year 3 to 6, lasting 1 to 15 months. Twenty-six programs have 2 to 3 participating sites and 41 have 4 to 6 sites distinct from the host program. Programs frequently offset potential financial harm to residents rotating at a distant site by support of housing and transportation costs. As medical systems experience fluctuating treatment paradigms and demographics, over time, more residency programs may adapt to meet the Accreditation Council of Graduate Medical Education case minimum requirements through the implementation of away rotations.

  6. History and Guideline of Emergency Medicine Residency Discipline in Shahid Beheshti University of Medical Sciences, Iran; Review of 2014

    Directory of Open Access Journals (Sweden)

    Majid Shojaee

    2014-09-01

    Full Text Available Introduction: Since many years ago several problems have been felt in emergency departments (ED of hospitals. In fact, none of physicians in the hospital have accepted the direct responsibility of patients’ management in the EDs and emergency wards of University centers have been managed by residents of various disciplines. Thus, the first line of therapy does not have guardian and several consultants with various specialists have been performed regarding patient’s management. The necessity of physician training was noticed for the first time in 1950 and after 24 years in 1974, the academic emergency medicine was established in United States of America (USA in response to people expectations for overnight accessibility to specialized and quality medical cares. It was performed with foundation of the first period of resident’s training in emergency medicine discipline at University of Cincinnati, Ohio. At beginning, specialists of different fields such as internal medicine, surgery, anesthesia, orthopedics, and neurosurgery initiated the training of emergency medicine residents together which could be responsible to most of referees. Finally, with formal accepting the specialty board in 1978, this field has been officially identified as the 23th discipline in USA. Today the EDs of most hospitals in European and American countries has been managing by emergency medicine specialists which leads to improve the quality of education and treatment, significantly. Also in Iran the request of establishing this major has been presented in the secretariat of the council for graduate medical education for the first time in 1996. This request was approved and principles of its initiating recognized officially by the ministry of health. But, considering to lack of an appropriate infrastructure, it postponed until 2000 that again this discipline was missioned for initiating to the council for graduate medical education by the minister and its outcome was

  7. Reliability of a structured interview for admission to an emergency medicine residency program.

    Science.gov (United States)

    Blouin, Danielle

    2010-10-01

    Interviews are most important in resident selection. Structured interviews are more reliable than unstructured ones. We sought to measure the interrater reliability of a newly designed structured interview during the selection process to an Emergency Medicine residency program. The critical incident technique was used to extract the desired dimensions of performance. The interview tool consisted of 7 clinical scenarios and 1 global rating. Three trained interviewers marked each candidate on all scenarios without discussing candidates' responses. Interitem consistency and estimates of variance were computed. Twenty-eight candidates were interviewed. The generalizability coefficient was 0.67. Removing the central tendency ratings increased the coefficient to 0.74. Coefficients of interitem consistency ranged from 0.64 to 0.74. The structured interview tool provided good although suboptimal interrater reliability. Increasing the number of scenarios improves reliability as does applying differential weights to the rating scale anchors. The latter would also facilitate the identification of those candidates with extreme ratings.

  8. Contrast reaction training in US radiology residencies: a COARDRI study.

    Science.gov (United States)

    LeBedis, Christina A; Rosenkrantz, Andrew B; Otero, Hansel J; Decker, Summer J; Ward, Robert J

    To perform a survey-based assessment of current contrast reaction training in US diagnostic radiology residency programs. An electronic survey was distributed to radiology residency program directors from 9/2015-11/2015. 25.7% of programs responded. 95.7% of those who responded provide contrast reaction management training. 89.4% provide didactic lectures (occurring yearly in 71.4%). 37.8% provide hands-on simulation training (occurring yearly in 82.3%; attended by both faculty and trainees in 52.9%). Wide variability in contrast reaction education in US diagnostic radiology residency programs reveals an opportunity to develop and implement a national curriculum. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Using television shows to teach communication skills in internal medicine residency.

    Science.gov (United States)

    Wong, Roger Y; Saber, Sadra S; Ma, Irene; Roberts, J Mark

    2009-02-03

    To address evidence-based effective communication skills in the formal academic half day curriculum of our core internal medicine residency program, we designed and delivered an interactive session using excerpts taken from medically-themed television shows. We selected two excerpts from the television show House, and one from Gray's Anatomy and featured them in conjunction with a brief didactic presentation of the Kalamazoo consensus statement on doctor-patient communication. To assess the efficacy of this approach a set of standardized questions were given to our residents once at the beginning and once at the completion of the session. Our residents indicated that their understanding of an evidence-based model of effective communication such as the Kalamazoo model, and their comfort levels in applying such model in clinical practice increased significantly. Furthermore, residents' understanding levels of the seven essential competencies listed in the Kalamazoo model also improved significantly. Finally, the residents reported that their comfort levels in three challenging clinical scenarios presented to them improved significantly. We used popular television shows to teach residents in our core internal medicine residency program about effective communication skills with a focus on the Kalamazoo's model. The results of the subjective assessment of this approach indicated that it was successful in accomplishing our objectives.

  10. Family medicine residents' practice intentions: Theory of planned behaviour evaluation.

    Science.gov (United States)

    Grierson, Lawrence E M; Fowler, Nancy; Kwan, Matthew Y W

    2015-11-01

    To assess residents' practice intentions since the introduction of the College of Family Physicians of Canada's Triple C curriculum, which focuses on graduating family physicians who will provide comprehensive care within traditional and newer models of family practice. A survey based on Ajzen's theory of planned behaviour was administered on 2 occasions. McMaster University in Hamilton, Ont. Residents (n = 135) who were enrolled in the Department of Family Medicine Postgraduate Residency Program at McMaster University in July 2012 and July 2013; 54 of the 60 first-year residents who completed the survey in 2012 completed it again in 2013. The survey was modeled so as to measure the respondents' intentions to practise with a comprehensive scope; determine the degree to which their attitudes, subjective norms, and perceptions of control about comprehensive practice influence those intentions; and investigate how these relationships change as residents progress through the curriculum. The survey also queried the respondents about their intentions with respect to particular medical services that underpin comprehensive practice. The responses indicate that the factors modeled by the theory of planned behaviour survey account for 60% of the variance in the residents' intentions to adopt a comprehensive scope of practice upon graduation, that there is room for curricular improvement with respect to encouraging residents to practise comprehensive care, and that targeting subjective norms about comprehensive practice might have the greatest influence on improving resident intentions. The theory of planned behaviour presents an effective approach to assessing curricular effects on resident practice intentions while also providing meaningful information for guiding further program evaluation efforts in the Department of Family Medicine at McMaster University.

  11. The pediatric residency training on tobacco project: four-year parent outcome findings.

    Science.gov (United States)

    Hymowitz, Norman; Pyle, Sara A; Haddock, C Keith; Schwab, Joseph V

    2008-08-01

    To assess parent behavioral change and perception of resident intervention on tobacco. In a long-term study of the efficacy of training pediatric residents to address tobacco conducted at the New Jersey Medical School, sixteen pediatric training programs were assigned randomly to either special or standard training conditions. Parent surveys were administered in the fall of 2001 and 2005 in order to assess the effects of resident intervention on parent behavior, as well as parent perceptions of resident intervention. The percent of parents who smoke at sites associated with the special training condition, but not of those at sites associated with standard training, who reported that residents advised them to stop smoking, offered to help them quit, and provided quit smoking materials increased significantly from baseline to year 4. The percent of parents in the special training condition who reported quitting smoking in the past year also increased, although the increase was not statistically significant. A majority of the parents associated with each training condition reported receiving intervention for second hand smoke (SHS). For each training condition, the level of intervention to prevent exposure of infants and children to SHS exposure was similar at baseline and year 4, as was the percent of parents who reported having a smoke-free household. The results support the efficacy of the special training program and underscore the importance of preparing pediatric residents to address tobacco.

  12. Support for and aspects of use of educational games in family medicine and internal medicine residency programs in the US: a survey

    OpenAIRE

    Wilson Mark C; Mustafa Reem; Gunukula Sameer; Akl Elie A; Symons Andrew; Moheet Amir; Schünemann Holger J

    2010-01-01

    Abstract Background The evidence supporting the effectiveness of educational games in graduate medical education is limited. Anecdotal reports suggest their popularity in that setting. The objective of this study was to explore the support for and the different aspects of use of educational games in family medicine and internal medicine residency programs in the United States. Methods We conducted a survey of family medicine and internal medicine residency program directors in the United Stat...

  13. Burnout syndrome during residency in internal medicine and pediatrics in a country without working time directive.

    Science.gov (United States)

    Aksoy, Duygu Yazgan; Durusu Tanriover, Mine; Unal, Sule; Dizdar, Omer; Kalyoncu, Umut; Karakaya, Jale; Unal, Serhat; Kale, Gulsev

    2014-01-01

    The purpose of this paper is to demonstrate burnout syndrome among internal medicine and pediatrics residents in a country that does not have the working time directive (WTD) and also to determine the risk factors and consequent impact on efficient functioning in clinical areas. A 57-item questionnaire was given to internal medicine and pediatrics residents. Responses from 22 pediatrics and 33 internal medicine residents were evaluated. Demographic findings, burnout scores, having hobbies, social activities and reading books unrelated to medicine were similar between the two groups. Six pediatrics residents (27.3 per cent) and 11 (33.3 per cent) internal medicine residents met the criteria for clinically significant burnout. Personal accomplishment scores and reading books unrelated to medicine were found to be related to burnout. Burnout is a syndrome characterized by depersonalization, emotional exhaustion and a low sense of personal accomplishment. It is important to document burnout in countries where WTDs are not implemented. Further studies might demonstrate burnout's effect on patient safety, service quality and physician's performance.

  14. Finding the Perfect Match: Factors That Influence Family Medicine Residency Selection.

    Science.gov (United States)

    Wright, Katherine M; Ryan, Elizabeth R; Gatta, John L; Anderson, Lauren; Clements, Deborah S

    2016-04-01

    Residency program selection is a significant experience for emerging physicians, yet there is limited information about how applicants narrow their list of potential programs. This study examines factors that influence residency program selection among medical students interested in family medicine at the time of application. Medical students with an expressed interest in family medicine were invited to participate in a 37-item, online survey. Students were asked to rate factors that may impact residency selection on a 6-point Likert scale in addition to three open-ended qualitative questions. Mean values were calculated for each survey item and were used to determine a rank order for selection criteria. Logistic regression analysis was performed to identify factors that predict a strong interest in urban, suburban, and rural residency programs. Logistic regression was also used to identify factors that predict a strong interest in academic health center-based residencies, community-based residencies, and community-based residencies with an academic affiliation. A total of 705 medical students from 32 states across the country completed the survey. Location, work/life balance, and program structure (curriculum, schedule) were rated the most important factors for residency selection. Logistic regression analysis was used to refine our understanding of how each factor relates to specific types of residencies. These findings have implications for how to best advise students in selecting a residency, as well as marketing residencies to the right candidates. Refining the recruitment process will ensure a better fit between applicants and potential programs. Limited recruitment resources may be better utilized by focusing on targeted dissemination strategies.

  15. Results of a Formal Mentorship Program for Internal Medicine Residents: Can We Facilitate Genuine Mentorship?

    Science.gov (United States)

    Cohee, Brian M; Koplin, Stephen A; Shimeall, William T; Quast, Timothy M; Hartzell, Joshua D

    2015-03-01

    Mentorship programs are perceived as valuable, yet little is known about the effect of program design on mentoring effectiveness. We developed a program focused on mentoring relationship quality and evaluated how subsequent relationships compared to preexisting informal pairings. Faculty members were invited by e-mail to participate in a new mentoring program. Participants were asked to complete a biography, subsequently provided to second- and third-year internal medicine residents. Residents were instructed to contact available mentors, and ultimately designate a formal mentor. All faculty and residents were provided a half-day workshop training, written guidelines, and e-mails. Reminders were e-mailed and announced in conferences approximately monthly. Residents were surveyed at the end of the academic year. Thirty-seven faculty members completed the biography, and 70% (26 of 37) of residents responded to the survey. Of the resident respondents, 77% (20 of 26) chose a formal mentor. Of the remainder, most had a previous informal mentor. Overall, 96% (25 of 26) of the residents had identified a mentor of some kind compared to 50% (13 of 26) before the intervention (P mentors identified them as actual mentors. Similar numbers of residents described their mentors as invested in the mentorship, and there was no statistical difference in the number of times mentors and mentees met. Facilitated selection of formal mentors produced relationships similar to preexisting informal ones. This model may increase the prevalence of mentorship without decreasing quality.

  16. Effect of didactic lectures on obesity documentation and counseling among internal medicine residents.

    Science.gov (United States)

    Ren, Vicky; Ellison, Kathleen; Miller, Jonathan; Busireddy, Kiran; Vickery, Erin; Panda, Mukta; Qayyum, Rehan

    2016-01-01

    Screening adult patients for obesity and offering appropriate counseling and treatment for weight loss is recommended. However, many healthcare providers feel ill-equipped to address this topic. We examined whether didactic presentations lead to increased obesity documentation and counseling among internal medicine (IM) residents. We reviewed medical records of patients seen at the IM Resident Continuity Clinic during April 2015. Residents were provided feedback at two didactic presentations during May 2015. To examine the effect of this intervention, we repeated medical record review during June 2015. For both reviews, we abstracted patient-specific (i.e., age, body mass index [BMI], race, sex, and number of comorbid diagnoses) and resident-specific (i.e., sex and training level) data as well as evidence of obesity documentation and counseling. We used logistic regression models to examine the effect of intervention on obesity documentation and counseling, adjusting for patient- and resident-specific variables. Of the 278 patients with BMI≥30 kg/m(2), 139 were seen before and 139 after the intervention. Intervention had no effect on obesity documentation or counseling with or without adjustment for confounding variables (both P>0.05). In adjusted post-hoc analyses, each additional comorbidity increased the odds of obesity documentation by 8% (OR=1.08; 95% CI=1.05-1.11; Pdidactic presentations were unable to increase obesity documentation or weight loss counseling. Future research to identify effective interventions is needed.

  17. Effectiveness and Organization of Addiction Medicine Training Across the Globe.

    Science.gov (United States)

    Ayu, Astri Parawita; Schellekens, Arnt F A; Iskandar, Shelly; Pinxten, Lucas; De Jong, Cor A J

    2015-01-01

    Over the past decade, addiction medicine training curricula have been developed to prepare physicians to work with substance use disorder patients. This review paper aimed at (1) summarizing scientific publications that outline the content of addiction medicine curricula and (2) evaluating the evidence for efficacy for training in addiction medicine. We carried out a literature search on articles about addiction medicine training initiatives across the world, using PubMed, PsychINFO and EMBASE with the following search terms 'substance abuse, addiction medicine, education and training.' We found 29 articles on addiction medicine curricula at various academic levels. Nine studies reported on the need for addiction medicine training, 9 described addiction medicine curricula at various academic levels, and 11 described efficacy on addiction medicine curricula. Several key competences in addiction medicine were identified. Efficacy studies show that even short addiction medicine training programs can be effective in improving knowledge, skills and attitudes related to addiction medicine. A more uniform approach to addiction medicine training in terms of content and accreditation is discussed. © 2015 S. Karger AG, Basel.

  18. Residency Training: The need for an integrated diversity curriculum for neurology residency.

    Science.gov (United States)

    Rosendale, Nicole; Josephson, S Andrew

    2017-12-12

    Providing culturally responsive care to an increasingly multicultural population is essential and requires formal cultural humility training for residents. We sought to understand the current prevalence and need for this type of training within neurology programs and to pilot an integrated curriculum locally. We surveyed via email all program directors of academic neurology programs nationally regarding the prevalence of and need for formal cultural responsiveness training. Forty-seven program directors (36%) responded to the survey. The majority of respondents did not have a formalized diversity curriculum in their program (65%), but most (85%) believed that training in cultural responsiveness was important. We developed locally an integrated diversity curriculum as a proof of concept. The curriculum covered topics of diversity in language, religion, sexual orientation, gender identity/expression, and socioeconomic status designed to focus on the needs of the local community. Program evaluation included a pre and post survey of the learner attitudes toward cultural diversity. There is an unmet need for cultural responsiveness training within neurology residencies, and integrating this curriculum is both feasible and efficacious. When adapted to address cultural issues of the local community, this curriculum can be generalizable to both academic and community organizations. © 2017 American Academy of Neurology.

  19. Training, Research, and Working Conditions for Urology Residents in Germany: A Contemporary Survey.

    Science.gov (United States)

    Borgmann, Hendrik; Arnold, Hannah K; Meyer, Christian P; Bründl, Johannes; König, Justus; Nestler, Tim; Ruf, Christian; Struck, Julian; Salem, Johannes

    2016-12-16

    Excellent uniform training of urology residents is crucial to secure both high-quality patient care and the future of our specialty. Residency training has come under scrutiny following the demands of subspecialized care, economical aspects, and working hour regulations. To comprehensively assess the surgical training, research opportunities, and working conditions among urology residents in Germany. We sent a 29-item online survey via email to 721 members of the German Society of Residents in Urology. Descriptive analyses were conducted to describe the surveys' four domains: (1) baseline characteristics, (2) surgical training (cumulative completed case volume for all minor-, medium-, and major-complexity surgeries), (3) research opportunities, and (4) working conditions. Four hundred and seventy-two residents completed the online survey (response rate 65%). Surgical training: the median number of cumulative completed cases for postgraduate yr (PGY)-5 residents was 113 (interquartile range: 76-178). Minor surgeries comprised 57% of all surgeries and were performed by residents in all PGYs. Medium-complexity surgeries comprised 39% of all surgeries and were mostly performed by residents in PGYs 2-5. Major surgeries comprised 4% of all surgeries and were occasionally performed by residents in PGYs 3-5. Research opportunities: some 44% have attained a medical thesis (Dr. med.), and 39% are currently pursuing research. Working conditions: psychosocial work-related stress was high and for 82% of residents their effort exceeded their rewards. Some 44% were satisfied, 32% were undecided, and 24% were dissatisfied with their current working situation. Limitations include self-reported survey answers and a lack of validated assessment tools. Surgical exposure among German urology residents is low and comprises minor and medium-complex surgeries. Psychosocial work-related stress is high for the vast majority of residents indicating the need for structural improvements in

  20. Acceptability and Impact of a Required Palliative Care Rotation with Prerotation and Postrotation Observed Simulated Clinical Experience during Internal Medicine Residency Training on Primary Palliative Communication Skills.

    Science.gov (United States)

    Vergo, Maxwell T; Sachs, Sharona; MacMartin, Meredith A; Kirkland, Kathryn B; Cullinan, Amelia M; Stephens, Lisa A

    2017-05-01

    Improving communication training for primary palliative care using a required palliative care rotation for internal medicine (IM) residents has not been assessed. To assess skills acquisition and acceptability for IM residents not selecting an elective. A consecutive, single-arm cohort underwent preobjective structured clinical examination (OSCE) with learner-centric feedback, two weeks of clinical experience, and finally a post-OSCE to crystallize learner-centric take home points. IM second year residents from Dartmouth-Hitchcock were exposed to a required experiential palliative care rotation. Pre- and post-OSCE using a standardized score card for behavioral skills, including patient-centered interviewing, discussing goals of care/code status, and responding to emotion, as well as a confidential mixed qualitative and quantitative evaluation of the experience. Twelve residents were included in the educational program (two were excluded because of shortened experiences) and showed statistically significant improvements in overall communication and more specifically in discussing code status and responding to emotions. General patient-centered interviewing skills were not significantly improved, but prerotation scores reflected pre-existing competency in this domain. Residents viewed the observed simulated clinical experience (OSCE) and required rotation as positive experiences, but wished for more opportunities to practice communication skills in real clinical encounters. A required palliative care experiential rotation flanked by OSCEs at our institution improved the acquisition of primary palliative care communication skills similarly to other nonclinical educational platforms, but may better meet the needs of the resident and faculty as well as address all required ACGME milestones.

  1. Evidence-based medicine Training: Kazakhstan experience.

    Science.gov (United States)

    Kamalbekova, G; Kalieva, M

    2015-01-01

    Understanding principles of evidence-based medicine is of vital importance for improving quality of care, promoting public health and health system development. Understanding principles of evidence-based medicine allows using the most powerful information source, which have ever existed in medicine. To evaluate the effectiveness of teaching Evidence-Based Medicine, including long-term outcomes of training. The study was conducted at the Medical University of Astana, where the Scientific and Educational Center of Evidence-Based Medicine was established in 2010 with the help of the corresponding project of the World Bank. The participants of the study were the faculty trained in Evidence-Based Medicine at the workshop "Introduction to Evidence-Based Medicine" for the period of 2010-2015 years. There were a total of 16 workshops during the period, and 323 employees were trained. All participants were asked to complete our questionnaire two times: before the training - pre-training (to determine the initial level of a listener) and after the training - post-training (to determine the acquired level and get the feedback). Questionnaires were prepared in such a way, that the majority of questions before and after training were identical. Thus, it provided a clear picture of the effectiveness of training. Questions in the survey were open-ended so that the respondents had the opportunity to freely and fully express their views. The main part of the questionnaires included the following questions: "Do you understand what evidence-based medicine is", "how do you understand what the study design means", "what is randomization", "how research is classified", "do you know the steps of decision-making according to Evidence-Based Medicine, list them", "what literature do you prefer to use when searching for information (print, electronic, etc.)", "what resources on the Internet do you prefer to use". Only 30-35% of respondents gave correct answers to the questions on

  2. Swiss residents' arguments for and against a career in medicine

    Directory of Open Access Journals (Sweden)

    Klaghofer Richard

    2006-08-01

    Full Text Available Abstract Background In some Western countries, the medical profession is continuously losing prestige, doctors are claiming of high demands, low rewards, and difficult structural working conditions. This study aimed to investigate the arguments given by Swiss residents for and against a career in medicine. Methods As part of a prospective cohort study of Swiss medical school graduates on career development, 567 fourth-year residents were asked to answer the free-response item of what arguments there still were in favour of or against a career in medicine. They also indicated whether they would choose the medical profession all over again (yes/no. The statements were transcribed, content categories inductively formulated, and their descriptions written down in a code manual. Arguments were encoded according to the code manual and assigned to eight content categories (Mayring's content analysis. Frequency distributions were given for categories and tested with Chi2-tests for differences in gender, speciality fields, and whether or not the respondent would again choose a career in medicine. Results The 567 participants made 1,640 statements in favour of and 1,703 statements against a career in medicine. The content analysis of the residents' answers yielded eight categories with arguments both for and against a career in medicine. Of all "statements for" responses, 70% fell into the two top-ranking categories of Personal experiences in day-to-day working life (41.2% and Interpersonal experiences in professional relationships (28.8%. The top-ranking category of the "statements against" arguments was General work-related structural conditions (32%, followed by Social prestige and health-policy aspects (21%. Main arguments in favour of a career in medicine were interdisciplinary challenge, combination of basic sciences and interpersonal concerns, helping suffering people, guarantee of a secure job; arguments against comprised high workload, time

  3. Permanent resident

    Directory of Open Access Journals (Sweden)

    John F. Fisher

    2016-05-01

    Full Text Available The training of physicians in the past century was based primarily on responsibility and the chain-of-command. Those with the bulk of that responsibility in the fields of pediatrics and internal medicine were residents. Residents trained the medical students and supervised them carefully in caring for patients. Most attending physicians supervised their teams at arm's length, primarily serving as teachers of the finer points of diagnosis and treatment during set periods of the day or week with a perfunctory signature on write-ups or progress notes. Residents endeavored to protect the attending physician from being heavily involved unless they were unsure about a clinical problem. Before contacting the attending physician, a more senior resident would be called. Responsibility was the ultimate teacher. The introduction of diagnosis-related groups by the federal government dramatically changed the health care delivery system, placing greater emphasis on attending physician visibility in the medical record, ultimately resulting in more attending physician involvement in day-to-day care of patients in academic institutions. Without specified content in attending notes, hospital revenues would decline. Although always in charge technically, attending physicians increasingly have assumed the role once dominated by the resident. Using biographical experiences of more than 40 years, the author acknowledges and praises the educational role of responsibility in his own training and laments its declining role in today's students and house staff.

  4. The role of simulation training in anesthesiology resident education.

    Science.gov (United States)

    Yunoki, Kazuma; Sakai, Tetsuro

    2018-03-09

    An increasing number of reports indicate the efficacy of simulation training in anesthesiology resident education. Simulation education helps learners to acquire clinical skills in a safe learning environment without putting real patients at risk. This useful tool allows anesthesiology residents to obtain medical knowledge and both technical and non-technical skills. For faculty members, simulation-based settings provide the valuable opportunity to evaluate residents' performance in scenarios including airway management and regional, cardiac, and obstetric anesthesiology. However, it is still unclear what types of simulators should be used or how to incorporate simulation education effectively into education curriculums. Whether simulation training improves patient outcomes has not been fully determined. The goal of this review is to provide an overview of the status of simulation in anesthesiology resident education, encourage more anesthesiologists to get involved in simulation education to propagate its influence, and stimulate future research directed toward improving resident education and patient outcomes.

  5. Internal Medicine Resident Engagement with a Laboratory Utilization Dashboard: Mixed Methods Study.

    Science.gov (United States)

    Kurtzman, Gregory; Dine, Jessica; Epstein, Andrew; Gitelman, Yevgenly; Leri, Damien; Patel, Miltesh S; Ryskina, Kyra

    2017-09-01

    The objective of this study was to measure internal medicine resident engagement with an electronic medical record-based dashboard providing feedback on their use of routine laboratory tests relative to service averages. From January 2016 to June 2016, residents were e-mailed a snapshot of their personalized dashboard, a link to the online dashboard, and text summarizing the resident and service utilization averages. We measured resident engagement using e-mail read-receipts and web-based tracking. We also conducted 3 hour-long focus groups with residents. Using grounded theory approach, the transcripts were analyzed for common themes focusing on barriers and facilitators of dashboard use. Among 80 residents, 74% opened the e-mail containing a link to the dashboard and 21% accessed the dashboard itself. We did not observe a statistically significant difference in routine laboratory ordering by dashboard use, although residents who opened the link to the dashboard ordered 0.26 fewer labs per doctor-patient-day than those who did not (95% confidence interval, -0.77 to 0.25; = 0 .31). While they raised several concerns, focus group participants had positive attitudes toward receiving individualized feedback delivered in real time. © 2017 Society of Hospital Medicine.

  6. Workplace Violence and Harassment Against Emergency Medicine Residents.

    Science.gov (United States)

    Schnapp, Benjamin H; Slovis, Benjamin H; Shah, Anar D; Fant, Abra L; Gisondi, Michael A; Shah, Kaushal H; Lech, Christie A

    2016-09-01

    Several studies have shown that workplace violence in the emergency department (ED) is common. Residents may be among the most vulnerable staff, as they have the least experience with these volatile encounters. The goal for this study was to quantify and describe acts of violence against emergency medicine (EM) residents by patients and visitors and to identify perceived barriers to safety. This cross-sectional survey study queried EM residents at multiple New York City hospitals. The primary outcome was the incidence of violence experienced by residents while working in the ED. The secondary outcomes were the subtypes of violence experienced by residents, as well as the perceived barriers to safety while at work. A majority of residents (66%, 78/119) reported experiencing at least one act of physical violence during an ED shift. Nearly all residents (97%, 115/119) experienced verbal harassment, 78% (93/119) had experienced verbal threats, and 52% (62/119) reported sexual harassment. Almost a quarter of residents felt safe "Occasionally," "Seldom" or "Never" while at work. Patient-based factors most commonly cited as contributory to violence included substance use and psychiatric disease. Self-reported violence against EM residents appears to be a significant problem. Incidence of violence and patient risk factors are similar to what has been found previously for other ED staff. Understanding the prevalence of workplace violence as well as the related systems, environmental, and patient-based factors is essential for future prevention efforts.

  7. Using television shows to teach communication skills in internal medicine residency

    Directory of Open Access Journals (Sweden)

    Ma Irene

    2009-02-01

    Full Text Available Abstract Background To address evidence-based effective communication skills in the formal academic half day curriculum of our core internal medicine residency program, we designed and delivered an interactive session using excerpts taken from medically-themed television shows. Methods We selected two excerpts from the television show House, and one from Gray's Anatomy and featured them in conjunction with a brief didactic presentation of the Kalamazoo consensus statement on doctor-patient communication. To assess the efficacy of this approach a set of standardized questions were given to our residents once at the beginning and once at the completion of the session. Results Our residents indicated that their understanding of an evidence-based model of effective communication such as the Kalamazoo model, and their comfort levels in applying such model in clinical practice increased significantly. Furthermore, residents' understanding levels of the seven essential competencies listed in the Kalamazoo model also improved significantly. Finally, the residents reported that their comfort levels in three challenging clinical scenarios presented to them improved significantly. Conclusion We used popular television shows to teach residents in our core internal medicine residency program about effective communication skills with a focus on the Kalamazoo's model. The results of the subjective assessment of this approach indicated that it was successful in accomplishing our objectives.

  8. The impact of critical appraisal workshops on residents' evidence based medicine skills and knowledge

    Directory of Open Access Journals (Sweden)

    Nasr JA

    2018-04-01

    Full Text Available Justine A Nasr,1,2 John Falatko,1 Alexandra Halalau1,2 1Internal Medicine Department, Beaumont Hospital, Royal Oak, MI, USA; 2Internal Medicine Department, Oakland University William Beaumont School of Medicine, Rochester, MI, USA Objective: To assess the impact of four evidence based medicine (EBM critical appraisal education workshops in improving residents’ EBM knowledge and skills. Methods: The eligible participants in the workshops were 88 residents-in-training, postgraduate years one through four, rotating through the outpatient internal medicine clinic. Four EBM workshops, consisting of 3 days each (30 minutes daily, were taught by our faculty. Topics covered included critical appraisal of randomized controlled trials, case-control and cohort studies, diagnosis studies, and systematic reviews. Results: As a program evaluation, anonymous pre-workshop and post-workshop tests were administered. Each of the four sets of tests showed improvement in scores: therapy from 58% to 77% (42% response rate, harm from 65% to 73% (38% response rate, diagnosis from 49% to 68% (49% response rate, and systematic review from 57% to 72% (30% response rate. Conclusion: We found that teaching EBM in four short workshops improved EBM knowledge and critical appraisal skills related to the four topics. Keywords: evidence based medicine, medical education, assessment methods, graduate, instructional design, curriculum development, curriculum evaluation

  9. Lifestyle medicine course for family medicine residents: preliminary assessment of the impact on knowledge, attitudes, self-efficacy and personal health.

    Science.gov (United States)

    Malatskey, Lilach; Bar Zeev, Yael; Tzuk-Onn, Adva; Polak, Rani

    2017-09-01

    The WHO estimates that by 2020 two-thirds of the diseases worldwide will be the result of unhealthy lifestyle habits. Less than half of primary care physician graduates feel prepared to give lifestyle behaviour counselling. Our objective was to evaluate the impact of lifestyle medicine (LM) course on self-reported knowledge, attitudes, self-efficacy and health behaviour of family medicine residents. Based on the Israeli syllabus for the study of LM, we delivered five face to face 20 H courses. Pre/post data were collected by knowledge, attitudes, self-efficacy and personal health survey: RESULTS: A total of 112 family medicine residents participated in one of the five courses, of which 91 (81.3%) filled both pre and post surveys. Participates showed an improvement in self-reported knowledge and capacity to manage patients in regard to smoking, weight management and physical activity. An improvement was noted in personal health behaviour of overweight participant's in regard to self-reported physical activity. A comprehensive LM syllabus based course has a positive impact on family medicine residents LM counselling abilities. We suggest that LM course should be considered as a potential permanent addition to the family medicine residency programme. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  10. Resident simulation training in endoscopic endonasal surgery utilizing haptic feedback technology.

    Science.gov (United States)

    Thawani, Jayesh P; Ramayya, Ashwin G; Abdullah, Kalil G; Hudgins, Eric; Vaughan, Kerry; Piazza, Matthew; Madsen, Peter J; Buch, Vivek; Sean Grady, M

    2016-12-01

    Simulated practice may improve resident performance in endoscopic endonasal surgery. Using the NeuroTouch haptic simulation platform, we evaluated resident performance and assessed the effect of simulation training on performance in the operating room. First- (N=3) and second- (N=3) year residents were assessed using six measures of proficiency. Using a visual analog scale, the senior author scored subjects. After the first session, subjects with lower scores were provided with simulation training. A second simulation served as a task-learning control. Residents were evaluated in the operating room over six months by the senior author-who was blinded to the trained/untrained identities-using the same parameters. A nonparametric bootstrap testing method was used for the analysis (Matlab v. 2014a). Simulation training was associated with an increase in performance scores in the operating room averaged over all measures (p=0.0045). This is the first study to evaluate the training utility of an endoscopic endonasal surgical task using a virtual reality haptic simulator. The data suggest that haptic simulation training in endoscopic neurosurgery may contribute to improvements in operative performance. Limitations include a small number of subjects and adjudication bias-although the trained/untrained identity of subjects was blinded. Further study using the proposed methods may better describe the relationship between simulated training and operative performance in endoscopic Neurosurgery. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Effect of Experience of Internal Medicine Residents during Infectious Disease Elective on Future Infectious Disease Fellowship Application

    Science.gov (United States)

    2017-10-04

    Experience of !ntcrnal Medicine Residents during Infectious Disease Elective on Future lntCctious Di~casc Fcllo\\vship Application Sb. GRANT N_UMBER...undefined. Since 2008 at our institution. internal medicine (!!vi) residents have been required to do a four-\\\\’eek inpatient !D rotation as an intern... Medicine Residents during Infectious Disease Elective on Fut ure Infectious Disease Fellowship Application ~ Poeter# 1440 .,...._,: OVfil"S~ ti

  12. Use of computers and the Internet by residents in US family medicine programmes.

    Science.gov (United States)

    King, Richard V; Murphy-Cullen, Cassie L; Mayo, Helen G; Marcee, Alice K; Schneider, Gregory W

    2007-06-01

    Computers, personal digital assistants (PDA), and the Internet are widely used as resources in medical education and clinical care. Educators who intend to incorporate these resources effectively into residency education programmes can benefit from understanding how residents currently use these tools, their skills, and their preferences. The researchers sent questionnaires to 306 US family medicine residency programmes for all of their residents to complete. Respondents were 1177 residents from 125 (41%) programmes. Access to a computer was reported by 95% of respondents. Of these, 97% of desktop and 89% of laptop computers could access the Internet. Residents accessed various educational and clinical resources. Half felt they had 'intermediate' skills at Web searches, 23% had 'some skills,' and 27% were 'quite skilled.' Those under 30 years of age reported higher skill levels. Those who experienced a Web-based curriculum in medical school reported higher search skills and greater success in finding clinical information. Respondents preferred to use technology to supplement the didactic sessions offered in resident teaching conferences. Favourable conditions exist in family medicine residency programmes to implement a blend of traditional and technology-based learning experiences. These conditions include residents' experience, skills, and preferences.

  13. Internet Training to Respond to Aggressive Resident Behaviors

    Science.gov (United States)

    Irvine, A. Blair; Billow, Molly B.; Gates, Donna M.; Fitzwater, Evelyn L.; Seeley, John R.; Bourgeois, Michelle

    2012-01-01

    Purpose: This research evaluated an individualized Internet training designed to teach nurse aides (NAs) strategies to prevent or, if necessary, react to resident aggression in ways that are safe for the resident as well as the caregiver. Design and Methods: A randomized treatment and control design was implemented, with baseline, 1-, and 2-month…

  14. [Basic research during residency in Israel: is change needed?].

    Science.gov (United States)

    Fishbain, Dana; Shoenfeld, Yehuda; Ashkenazi, Shai

    2013-10-01

    A six-month research period is a mandatory part of the residency training program in most basic specialties in Israel and is named: the "basic science period". This is the only period in an Israeli physician's medical career which is dedicated strictly to research, accentuating the importance of medical research to the quality of training and level of medicine in Israel. From another point of view, one may argue that in an era of shortage of physicians on the one hand and the dizzying rate of growth in medical knowledge on the other hand, every moment spent training in residency is precious, therefore, making the decision of whether to dedicate six months for research becomes ever more relevant. This question is currently raised for discussion once again by the Scientific Council of the Israeli Medical Association. The Scientific Council lately issued a call for comments sent to all Israeli physicians, asking their opinion on several key questions regarding basic science research. Learning the public's opinion will serve as a background for discussion. A total of 380 physicians responded to the call and specified their standpoint on the subject, among them heads of departments, units and clinics, senior physicians and residents. The findings pointed to strong support in maintaining the research period as part of residency training due to its importance to medical training and medicine, although half the respondents supported the use of various alternative formats for research together with the existing format. Those alternative format suggestions will be thoroughly reviewed. A smaller group of respondents supported allowing residents a choice between two tracks--with or without a research period, and only a few were in favor of canceling the research requirement altogether. The writers maintain that the "basic science period" of research during residency training is vital and its contribution to the high level of specialists and high level of medicine requires its

  15. Clinical ethics in rehabilitation medicine: core objectives and algorithm for resident education.

    Science.gov (United States)

    Sliwa, J A; McPeak, L; Gittler, M; Bodenheimer, C; King, J; Bowen, J

    2002-09-01

    Described as the balance of values on either side of a moral dilemma, ethics and ethical issues are of increasing importance in the changing practice of rehabilitation medicine. Because the substance of ethics and true ethical issues can be difficult to identify, the education of rehabilitation residents in ethics can similarly be challenging. This article discusses topics pertinent to an understanding of clinical ethics in rehabilitation medicine and provides a method of teaching residents through an algorithm of ethical issues, learning objectives, and illustrative cases.

  16. Canadian residents’ perceptions of cross-cultural care training in graduate medical school

    Science.gov (United States)

    Singh, Barinder; Banwell, Emma; Groll, Dianne

    2017-01-01

    Background The Royal College of Physicians and Surgeons of Canada specifies both respect for diversity as a requirement of professionalism and culturally sensitive provision of medical care. The purpose of the present study was to evaluate the perception of preparedness and attitudes of medical residents to deliver cross-cultural care. Methods The Cross Cultural Care Survey was sent via e-mail to all Faculty of Medicine residents (approx. 450) in an academic health sciences centre. Comparisons were made between psychiatry residents, family medicine residents, and other residency groups with respect to training, preparedness, and skillfulness in delivering cross-cultural care. Results Seventy-three (16%) residents responded to the survey. Residents in psychiatry and family medicine reported significantly more training and formal evaluation regarding cross-cultural care than residents in other programs. However, there were no significant differences in self-reported preparedness and skillfulness. Residents in family medicine were more likely to report needing more practical experience working with diverse groups. Psychiatry residents were less likely to report inadequate cross-cultural training. Conclusion While most residents reported feeling skillful and prepared to work with culturally diverse groups, they report receiving little additional instruction or formal evaluation on this topic, particularly in programs other than psychiatry and family medicine. PMID:29354194

  17. [French training program for medical students in transfusion medicine. Transfusion Medicine Teachers' College].

    Science.gov (United States)

    Wautier, J-L; Cabaud, J-J; Cazenave, J-P; Fialon, P; Fruchart, M-F; Joussemet, M; Leblond, V; Muller, J-Y; Rouger, P; Vignon, D; Waller, C; Lefrère, J-J; Worms, B; Vileyn, F

    2005-02-01

    In France, transfusion medicine training program has been updated. A national committee of professors in transfusion medicine propose a series of 13 items which represent the minimum knowledge that general practitioners should possess. This overview of transfusion medicine is far below the level that specialists should reach and they will need an additional specialized training. Several French universities have set up their own training program which is quite similar to the work of the committee of professors. The following recommendations are not strict guidelines but is a common basis which will be improved in 2005 according to new evidence based transfusion medicine.

  18. Child Welfare Training in Child Psychiatry Residency: A Program Director Survey

    Science.gov (United States)

    Lee, Terry G.; Cox, Julia R.; Walker, Sarah C.

    2013-01-01

    Objective: This study surveys child psychiatry residency program directors in order to 1) characterize child welfare training experiences for child psychiatry residents; 2) evaluate factors associated with the likelihood of program directors' endorsing the adequacy of their child welfare training; and 3) assess program directors'…

  19. Research training among pediatric residency programs: a national assessment.

    Science.gov (United States)

    Abramson, Erika L; Naifeh, Monique M; Stevenson, Michelle D; Todd, Christopher; Henry, Emilie D; Chiu, Ya-Lin; Gerber, Linda M; Li, Su-Ting T

    2014-12-01

    The Accreditation Council for Graduate Medical Education (ACGME) states that "residents should participate in scholarly activity." However, there is little guidance for effectively integrating scholarly activity into residency. This study was conducted to understand how pediatric residency programs meet ACGME requirements and to identify characteristics of successful programs. The authors conducted an online cross-sectional survey of all pediatric residency program directors in October 2012, assessing program characteristics, resident participation in scholarly activity, program infrastructure, barriers, and outcomes. Multivariate logistic regression was used to identify characteristics of programs in the top quartile for resident scholarly activity participation. The response rate was 52.8% (105/199 programs). Seventy-seven (78.6%) programs required scholarly activity, although definitions were variable. When including only original research, systematic reviews or meta-analyses, and case reports or series with references, resident participation averaged 56% (range 0%-100%). Characteristics associated with high-participation programs included a scholarly activity requirement (odds ratio [OR] = 5.5, 95% confidence interval [CI] = 1.03-30.0); program director belief that all residents should present work regionally or nationally (OR = 4.7, 95% CI = 1.5-15.1); and mentorship by >25% of faculty (OR = 3.6, CI = 1.2-11.4). Only 47.1% (41) of program directors were satisfied with resident participation, and only 30.7% (27) were satisfied with the quality of research training provided. The findings suggest that resident scholarly activity experience is highly variable and suboptimal. Identifying characteristics of successful programs can improve the resident research training experience.

  20. Comparison of Emergency Medicine Malpractice Cases Involving Residents to Non-Resident Cases.

    Science.gov (United States)

    Gurley, Kiersten L; Grossman, Shamai A; Janes, Margaret; Yu-Moe, C Winnie; Song, Ellen; Tibbles, Carrie D; Shapiro, Nathan I; Rosen, Carlo L

    2018-04-17

    Data are lacking on how emergency medicine (EM) malpractice cases with resident involvement differs from cases that do not name a resident. To compare malpractice case characteristics in cases where a resident is involved (resident case) to cases that do not involve a resident (non-resident case) and to determine factors that contribute to malpractice cases utilizing EM as a model for malpractice claims across other medical specialties. We used data from the Controlled Risk Insurance Company (CRICO) Strategies' division Comparative Benchmarking System (CBS) to analyze open and closed EM cases asserted from 2009-2013. The CBS database is a national repository that contains professional liability data on > 400 hospitals and > 165,000 physicians, representing over 30% of all malpractice cases in the U.S (> 350,000 claims). We compared cases naming residents (either alone or in combination with an attending) to those that did not involve a resident (non-resident cohort). We reported the case statistics, allegation categories, severity scores, procedural data, final diagnoses and contributing factors. Fisher's exact test or t-test was used for comparisons (alpha set at 0.05). Eight hundred and forty-five EM cases were identified of which 732 (87%) did not name a resident (non-resident cases), while 113 (13%) included a resident (resident cases) (Figure 1). There were higher total incurred losses for non-resident cases (Table 1). The most frequent allegation categories in both cohorts were "Failure or Delay in Diagnosis/Misdiagnosis" and "Medical Treatment" (non-surgical procedures or treatment regimens i.e. central line placement). Allegation categories of Safety and Security, Patient Monitoring, Hospital Policy and Procedure and Breach of Confidentiality were found in the non-resident cases. Resident cases incurred lower payments on average ($51,163 vs. $156,212 per case). Sixty six percent (75) of resident vs 57% (415) of non-resident cases were high severity claims

  1. Description of an ethics curriculum for a medicine residency program.

    OpenAIRE

    Silverman, H J

    1999-01-01

    This paper examines the attempts to develop and implement an ethics curriculum for the Internal Medicine Residency Program at the University of Maryland Medical Center. The objectives of the curriculum were to enhance moral reasoning skills and to promote humanistic attitudes and behavior among the residents. The diverse methodologies used to achieve these objectives included case discussions, literature reading, role playing, writing, and videos. These activities occurred predominantly withi...

  2. Workplace Violence and Harassment Against Emergency Medicine Residents

    Directory of Open Access Journals (Sweden)

    Benjamin H. Schnapp

    2016-09-01

    Full Text Available Introduction: Several studies have shown that workplace violence in the emergency department (ED is common. Residents may be among the most vulnerable staff, as they have the least experience with these volatile encounters. The goal for this study was to quantify and describe acts of violence against emergency medicine (EM residents by patients and visitors and to identify perceived barriers to safety. Methods: This cross-sectional survey study queried EM residents at multiple New York City hospitals. The primary outcome was the incidence of violence experienced by residents while working in the ED. The secondary outcomes were the subtypes of violence experienced by residents, as well as the perceived barriers to safety while at work. Results: A majority of residents (66%, 78/119 reported experiencing at least one act of physical violence during an ED shift. Nearly all residents (97%, 115/119 experienced verbal harassment, 78% (93/119 had experienced verbal threats, and 52% (62/119 reported sexual harassment. Almost a quarter of residents felt safe “Occasionally,” “Seldom” or “Never” while at work. Patient-based factors most commonly cited as contributory to violence included substance use and psychiatric disease. Conclusion: Self-reported violence against EM residents appears to be a significant problem. Incidence of violence and patient risk factors are similar to what has been found previously for other ED staff. Understanding the prevalence of workplace violence as well as the related systems, environmental, and patient-based factors is essential for future prevention efforts.

  3. Workplace Violence and Harassment Against Emergency Medicine Residents

    Science.gov (United States)

    Schnapp, Benjamin H.; Slovis, Benjamin H.; Shah, Anar D.; Fant, Abra L.; Gisondi, Michael A.; Shah, Kaushal H.; Lech, Christie A.

    2016-01-01

    Introduction Several studies have shown that workplace violence in the emergency department (ED) is common. Residents may be among the most vulnerable staff, as they have the least experience with these volatile encounters. The goal for this study was to quantify and describe acts of violence against emergency medicine (EM) residents by patients and visitors and to identify perceived barriers to safety. Methods This cross-sectional survey study queried EM residents at multiple New York City hospitals. The primary outcome was the incidence of violence experienced by residents while working in the ED. The secondary outcomes were the subtypes of violence experienced by residents, as well as the perceived barriers to safety while at work. Results A majority of residents (66%, 78/119) reported experiencing at least one act of physical violence during an ED shift. Nearly all residents (97%, 115/119) experienced verbal harassment, 78% (93/119) had experienced verbal threats, and 52% (62/119) reported sexual harassment. Almost a quarter of residents felt safe “Occasionally,” “Seldom” or “Never” while at work. Patient-based factors most commonly cited as contributory to violence included substance use and psychiatric disease. Conclusion Self-reported violence against EM residents appears to be a significant problem. Incidence of violence and patient risk factors are similar to what has been found previously for other ED staff. Understanding the prevalence of workplace violence as well as the related systems, environmental, and patient-based factors is essential for future prevention efforts. PMID:27625721

  4. Impact of a family medicine resident wellness curriculum: a feasibility study.

    Science.gov (United States)

    Runyan, Christine; Savageau, Judith A; Potts, Stacy; Weinreb, Linda

    2016-01-01

    Up to 60% of practicing physicians report symptoms of burnout, which often peak during residency. Residency is also a relevant time for habits of self-care and resiliency to be emphasized. A growing literature underscores the importance of this; however, evidence about effective burnout prevention curriculum during residency remains limited. The purpose of this project is to evaluate the impact of a new, 1-month wellness curriculum for 12 second-year family medicine residents on burnout, empathy, stress, and self-compassion. The pilot program, introduced during a new rotation emphasizing competencies around leadership, focused on teaching skills to cultivate mindfulness and self-compassion in order to enhance empathy and reduce stress. Pre-assessments and 3-month follow-up assessments on measures of burnout, empathy, self-compassion, and perceived stress were collected to evaluate the impact of the curriculum. It was hypothesized that this curriculum would enhance empathy and self-compassion as well as reduce stress and burnout among family medicine residents. Descriptive statistics revealed positive trends on the mean scores of all the measures, particularly the Mindfulness Scale of the Self-Compassion Inventory and the Jefferson Empathy Scale. However, the small sample size and lack of sufficient power to detect meaningful differences limited the use of inferential statistics. This feasibility study demonstrates how a residency wellness curriculum can be developed, implemented, and evaluated with promising results, including high participant satisfaction.

  5. Value of a regional family practice residency training program site

    Science.gov (United States)

    Fletcher, Sarah; Mullett, Jennifer; Beerman, Steve

    2014-01-01

    Abstract Objective To examine the perceptions of residents, nurses, and physicians about the effect of a regional family practice residency site on the delivery of health services in the community, as well as on the community health care providers. Design Interviews and focus groups were conducted. Setting Nanaimo, BC. Participants A total of 16 residents, 15 nurses, and 20 physicians involved with the family practice residency training program at the Nanaimo site. Methods A series of semistructured interviews and focus groups was conducted. Transcripts of interviews and focus groups were analyzed thematically by the research team. Main findings Overall, participants agreed that having a family practice residency training site in the community contributed to community life and to the delivery of health services in the following ways: increased community capacity and social capital; motivated positive relationships and attitudes in the hospital and community settings; improved communication and teamwork, as well as accessibility and understanding of the health care system; increased the standard of care; and facilitated the recruitment and retention of family physicians. Conclusion This family practice residency training site was beneficial for the community it served. Future planning for distributed medical education sites should take into account the effects of these sites on the health care community and ensure that they continue to be positive influences. Further research in this area could focus on patients’ perceptions of how residency programs affect their care, as well as on the effect of residency programs on wait times and workload for physicians and nurses. PMID:25217693

  6. Resident experience of abuse and harassment in emergency medicine: ten years later.

    Science.gov (United States)

    Li, Siu Fai; Grant, Kelly; Bhoj, Tanuja; Lent, Gretchen; Garrick, Jocelyn Freeman; Greenwald, Peter; Haber, Marc; Singh, Malini; Prodany, Karla; Sanchez, Leon; Dickman, Eitan; Spencer, James; Perera, Tom; Cowan, Ethan

    2010-02-01

    In 1995, a Society for Academic Emergency Medicine in-service survey reported high rates of verbal and physical abuse experienced by Emergency Medicine (EM) residents. We sought to determine the prevalence of abuse and harassment 10 years later to bring attention to these issues and determine if there has been a change in the prevalence of abuse over this time period. To determine the prevalence of abuse and harassment in a sample of EM residencies. We conducted a cross-section survey of EM residents from 10 residencies. EM residents were asked about their experience with verbal abuse, verbal threats, physical threats, physical attacks, sexual harassment, and racial harassment; and by whom. The primary outcome of the study was the prevalence of abuse and harassment as reported by EM residents. There were 196 of 380 residents (52%) who completed the survey. The prevalence of any type of abuse experienced was 91%; 86% of residents experienced verbal abuse, 65% verbal threats, 50% physical threats, 26% physical attacks, 23% sexual harassment, and 26% racial harassment. Women were more likely than men to encounter sexual harassment (37% [38/102] vs. 8% [7/92]; p harassment was not limited to minorities (23% [16/60] for Caucasians vs. 26% [29/126] for non-Caucasians; p = 0.59). Senior residents were more likely to have encountered verbal and physical abuse. Only 12% of residents formally reported the abuse they experienced. Abuse and harassment during EM residency continues to be commonplace and is underreported. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  7. Residency factors that influence pediatric in-training examination score improvement.

    Science.gov (United States)

    Chase, Lindsay H; Highbaugh-Battle, Angela P; Buchter, Susie

    2012-10-01

    The goal of this study was to determine which measurable factors of resident training experience contribute to improvement of in-training examination (ITE) and certifying examination (CE) scores. This is a descriptive retrospective study analyzing data from July 2003 through June 2006 at a large academic pediatric training program. Pediatric categorical residents beginning residency in July 2003 were included. Regression analyses were used to determine if the number of admissions performed, core lectures attended, acute care topics heard, grand rounds attended, continuity clinic patients encountered, or procedures performed correlated with improvement of ITE scores. These factors were then analyzed in relation to CE scores. Seventeen residents were included in this study. The number of general pediatric admissions was the only factor found to correlate with an increase in ITE score (P = .04). Scores for the ITE at pediatric levels 1 and 3 were predictive of CE scores. No other factors measured were found to influence CE scores. Although all experiences of pediatric residents likely contribute to professional competence, some experiences may have more effect on ITE and CE scores. In this study, only general pediatric admissions correlated significantly with an improvement in ITE scores from year 1 to year 3. Further study is needed to identify which elements of the residency experience contribute most to CE success. This would be helpful in optimizing residency program structure and curriculum within the limitations of duty hour regulations.

  8. Using Reflections of Recent Resident Graduates and their Pediatric Colleagues to Evaluate a Residency Program

    Directory of Open Access Journals (Sweden)

    Robert K. Kamei, M.D.

    2003-01-01

    Full Text Available Background and Purposes: In response to the new Accreditation Council for Graduate Medical Education (ACGME mandate for residency programs to use feedback to improve its educational program, we piloted a novel evaluation strategy of a residency program using structured interviews of resident graduates working in a primary care practice and their physician associates. Methods: A research assistant performed a structured telephone interview. Quantitative data assessing the graduate’s self-assessment and the graduate’s clinical practice by the associate were analyzed. In addition, we performed a qualitative analysis of the interviews. Results: Thirteen resident graduates in primary care practice and seven physician practice associates participated in the study. Graduate self-assessment revealed high satisfaction with their residency training and competency. The associates judged our graduates as highly competent and mentioned independent decision-making and strong interpersonal skills (such as teamwork and communication as important. They specifically cited the graduate’s skills in intensive care medicine and adolescent medicine as well as communication and teamwork skills as important contributions to their practice. Conclusions: The ACGME Outcomes Project, which increases the emphasis on educational outcomes in the accreditation of residency education programs, requires programs to provide evidence of its effectiveness in preparing residents for practice. Direct assessment of the competency of our physician graduates in practice using structured interviews of graduates and their practice associates provide useful feedback information to a residency program as part of a comprehensive evaluation plan of our program’s curriculum and can be used to direct future educational initiatives of our training program

  9. Effect of a Community-Based Service Learning Experience in Geriatrics on Internal Medicine Residents and Community Participants.

    Science.gov (United States)

    Miller, Rachel K; Michener, Jennifer; Yang, Phyllis; Goldstein, Karen; Groce-Martin, Jennine; True, Gala; Johnson, Jerry

    2017-09-01

    Community-based service learning (CBSL) provides an opportunity to teach internal medicine residents the social context of aging and clinical concepts. The objectives of the current study were to demonstrate the feasibility of a CBSL program targeting internal medicine residents and to assess its effect on medical residents and community participants. internal medicine residents participated in a CBSL experience for half a day during ambulatory blocks from 2011 to 2014. Residents attended a senior housing unit or center, delivered a presentation about a geriatric health topic, toured the facility, and received information about local older adult resources. Residents evaluated the experience. Postgraduate Year 3 internal medicine residents (n = 71) delivered 64 sessions. Residents felt that the experience increased their ability to communicate effectively with older adults (mean 3.91 ± 0.73 on a Likert scale with 5 = strongly agree), increased their knowledge of resources (4.09 ± 1.01), expanded their knowledge of a health topic pertinent to aging (3.48 ± 1.09), and contributed to their capacity to evaluate and care for older adults (3.84 ± 0.67). Free-text responses demonstrated that residents thought that this program would change their practice. Of 815 older adults surveyed from 36 discrete teaching sessions, 461 (56%) thought that the medical residents delivered health information clearly (4.55 ± 0.88) and that the health topics were relevant (4.26 ± 0.92). Free-text responses showed that the program helped them understand their health concerns. This CBSL program is a feasible and effective tool for teaching internal medicine residents and older adults. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  10. Video-Based Learning vs Traditional Lecture for Instructing Emergency Medicine Residents in Disaster Medicine Principles of Mass Triage, Decontamination, and Personal Protective Equipment.

    Science.gov (United States)

    Curtis, Henry A; Trang, Karen; Chason, Kevin W; Biddinger, Paul D

    2018-02-01

    Introduction Great demands have been placed on disaster medicine educators. There is a need to develop innovative methods to educate Emergency Physicians in the ever-expanding body of disaster medicine knowledge. The authors sought to demonstrate that video-based learning (VBL) could be a promising alternative to traditional learning methods for teaching disaster medicine core competencies. Hypothesis/Problem The objective was to compare VBL to traditional lecture (TL) for instructing Emergency Medicine residents in the American College of Emergency Physicians (ACEP; Irving, Texas USA) disaster medicine core competencies of patient triage and decontamination. A randomized, controlled pilot study compared two methods of instruction for mass triage, decontamination, and personal protective equipment (PPE). Emergency Medicine resident learning was measured with a knowledge quiz, a Likert scale measuring comfort, and a practical exercise. An independent samples t-test compared the scoring of the VBL with the TL group. Twenty-six residents were randomized to VBL (n=13) or TL (n=13). Knowledge score improvement following video (14.9%) versus lecture (14.1%) did not differ significantly between the groups (P=.74). Comfort score improvement also did not differ (P=.64) between video (18.3%) and lecture groups (15.8%). In the practical skills assessment, the VBL group outperformed the TL group overall (70.4% vs 55.5%; Plearning vs traditional lecture for instructing emergency medicine residents in disaster medicine principles of mass triage, decontamination, and personal protective equipment. Prehosp Disaster Med. 2018;33(1):7-12.

  11. Developing a Communication Curriculum and Workshop for an Internal Medicine Residency Program.

    Science.gov (United States)

    Salib, Sherine; Glowacki, Elizabeth M; Chilek, Lindsay A; Mackert, Michael

    2015-06-01

    Learning effective communication is essential for physicians. Effective communication has been shown to affect healthcare outcomes, including patient safety, adherence rates, patient satisfaction, and enhanced teamwork. The importance of these skills has become even more apparent in recent years, with value-based purchasing programs and federal measures of patient satisfaction in the form of Hospital Consumer Assessment of Healthcare Providers and Systems scores becoming an important part of measuring the performance of a healthcare facility. We conducted a communication workshop for internal medicine residents at the University of Texas. Topics covered included the Acknowledge, Introduce, Duration, Explanation, Thank You framework; managing up; resolving conflicts; error disclosure; new medication and discharge counseling; intercultural communication; understanding Hospital Consumer Assessment of Healthcare Providers and Systems scores; and avoiding burnout. Because it would have been logistically difficult to block whole days for the workshop, the various topics were offered to residents during their regular noon conference hour for several consecutive days. After the workshop, the residents completed an anonymous questionnaire regarding their perception of the importance of various aspects of communication in patient care. The majority of the participating residents perceived the various communication skills explored during the workshop to be highly important in patient care. Concurrently, however, most residents believed that they had initially overestimated their knowledge about these various communication issues. Some demographic differences in the responses also were noted. Our findings demonstrate a needs gap and an area of potential improvement in medical education. We anticipate that with the growing understanding of the importance of communication skills in the healthcare setting, there will be an enhanced role for teaching these skills at all levels of

  12. Improving the Teaching Skills of Residents in a Surgical Training Program: Results of the Pilot Year of a Curricular Initiative in an Ophthalmology Residency Program.

    Science.gov (United States)

    Chee, Yewlin E; Newman, Lori R; Loewenstein, John I; Kloek, Carolyn E

    2015-01-01

    To design and implement a teaching skills curriculum that addressed the needs of an ophthalmology residency training program, to assess the effect of the curriculum, and to present important lessons learned. A teaching skills curriculum was designed for the Harvard Medical School (HMS) Residency Training Program in Ophthalmology. Results of a needs assessment survey were used to guide curriculum objectives. Overall, 3 teaching workshops were conducted between October 2012 and March 2013 that addressed areas of need, including procedural teaching. A postcurriculum survey was used to assess the effect of the curriculum. Massachusetts Eye and Ear Infirmary, a tertiary care institution in Boston, MA. Overall, 24 residents in the HMS Residency Training Program in Ophthalmology were included. The needs assessment survey demonstrated that although most residents anticipated that teaching would be important in their future career, only one-third had prior formal training in teaching. All residents reported they found the teaching workshops to be either very or extremely useful. All residents reported they would like further training in teaching, with most residents requesting additional training in best procedural teaching practices for future sessions. The pilot year of the resident-as-teacher curriculum for the HMS Residency Training Program in Ophthalmology demonstrated a need for this curriculum and was perceived as beneficial by the residents, who reported increased comfort in their teaching skills after attending the workshops. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  13. [Needs assessment of a core curriculum for residency training].

    Science.gov (United States)

    Kwon, Hyo-Jin; Lee, Young-Mee; Chang, Hyung-Joo; Kim, Ae-Ri

    2015-09-01

    The core curriculum in graduate medical education (GME) is an educational program that covers the minimum body of knowledge and skills that is required of all residents, regardless of their specialty. This study examined the opinions of stakeholders in GME regarding the core curriculum. A questionnaire was administered at three tertiary hospitals that were affiliated with one university; 192 residents and 61 faculty members and attending physicians participated in the survey. The questionnaire comprised six items on physician competency and the needs for a core curriculum. Questions on subjects or topics and adequate training years for each topics were asked only to residents. Most residents (78.6%) and faculty members (86.9%) chose "medical expertise" as the "doctor's role in the 21st century." In contrast, communicator, manager, and collaborator were recognized by less than 30% of all participants. Most residents (74.1%) responded that a core curriculum is "necessary but not feasible," whereas 68.3% of faculty members answered that it is "absolutely needed." Regarding subjects that should be included in the core curriculum, residents and faculty members had disparate preferences- residents preferred more "management of a private clinic" and "financial management," whereas faculty members desired "medical ethics" and "communication skills." Residents and faculty members agree that residents should develop a wide range of competencies in their training. However, the perception of the feasibility and opinions on the contents of the core curriculum differed between groups. Further studies with larger samples should be conducted to define the roles and professional competencies of physicians and the needs for a core curriculum in GME.

  14. Evaluation of Problem- and Simulator-Based Learning in Lumbar Puncture in Adult Neurology Residency Training.

    Science.gov (United States)

    Sun, Chenjing; Qi, Xiaokun

    2018-01-01

    Lumbar puncture (LP) is an essential part of adult neurology residency training. Technologic as well as nontechnologic training is needed. However, current assessment tools mostly focus on the technologic aspects of LP. We propose a training method-problem- and simulator-based learning (PSBL)-in LP residency training to develop overall skills of neurology residents. We enrolled 60 neurology postgraduate-year-1 residents from our standardized residents training center and randomly divided them into 2 groups: traditional teaching group and PSBL group. After training, we assessed the extent that the residents were ready to perform LP and tracked successful LPs performed by the residents. We then asked residents to complete questionnaires about the training models. Performance scores and the results of questionnaires were compared between the 2 groups. Students and faculty concluded that PSBL provided a more effective learning experience than the traditional teaching model. Although no statistical difference was found in the pretest, posttest, and improvement rate scores between the 2 groups, based on questionnaire scores and number of successful LPs after training, the PSBL group showed a statistically significant improvement compared with the traditional group. Findings indicated that nontechnical elements, such as planning before the procedure and controlling uncertainties during the procedure, are more crucial than technical elements. Compared with traditional teaching model, PSBL for LP training can develop overall surgical skills, including technical and nontechnical elements, improving performance. Residents in the PSBL group were more confident and effective in performing LP. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Preparing Future Leaders: An Integrated Quality Improvement Residency Curriculum.

    Science.gov (United States)

    Potts, Stacy; Shields, Sara; Upshur, Carole

    2016-06-01

    The Accreditation Council for Graduate Medical Education (ACGME) has recognized the importance of quality improvement (QI) training and requires that accredited residencies in all specialties demonstrate that residents are "integrated and actively participate in interdisciplinary clinical quality improvement and patient safety activities." However, competing demands in residency training may make this difficult to accomplish. The study's objective is to develop and evaluate a longitudinal curriculum that meets the ACGME requirement for QI and patient safety training and links to patient-centered medical home (PCMH) practices. Residents in the Worcester Family Medicine Residency (WFMR) participated in a faculty-developed quality improvement curriculum that included web-based tutorials, quality improvement projects, and small-group sessions across all 3 years of residency. They completed self-evaluations of knowledge and use of curricular activities annually and at graduation, and comparisons were made between two graduating classes, as well as comparison of end of PGY2 to end of PGY3 for one class. Graduating residents who completed the full 3 years of the curriculum rated themselves as significantly more skilled in nine of 15 areas assessed at end of residency compared to after PGY2 and reported confidence in providing future leadership in a focus group. Five areas were also rated significantly higher than prior-year residents. Involving family medicine residents in a longitudinal curriculum with hands-on practice in implementing QI, patient safety, and chronic illness management activities that are inclusive of PCMH goals increased their self-perceived skills and leadership ability to implement these new and emerging evidence-based practices in primary care.

  16. Psychiatric Residents' Views of Quality of Psychotherapy Training and Psychotherapy Competencies: A Multisite Survey

    Science.gov (United States)

    Calabrese, Christina; Sciolla, Andres; Zisook, Sidney; Bitner, Robin; Tuttle, Jeffrey; Dunn, Laura B.

    2010-01-01

    Objective: Few studies of residents' attitudes toward psychotherapy training exist. The authors examined residents' perceptions of the quality of their training, support for training, their own competence levels, and associations between self-perceived competence and perceptions of the training environment. Methods: An anonymous, web-based…

  17. Training in intensive care medicine. A challenge within reach.

    Science.gov (United States)

    Castellanos-Ortega, A; Rothen, H U; Franco, N; Rayo, L A; Martín-Loeches, I; Ramírez, P; Cuñat de la Hoz, J

    2014-01-01

    The medical training model is currently immersed in a process of change. The new paradigm is intended to be more effective, more integrated within the healthcare system, and strongly oriented towards the direct application of knowledge to clinical practice. Compared with the established training system based on certification of the completion of a series or rotations and stays in certain healthcare units, the new model proposes a more structured training process based on the gradual acquisition of specific competences, in which residents must play an active role in designing their own training program. Training based on competences guarantees more transparent, updated and homogeneous learning of objective quality, and which can be homologated internationally. The tutors play a key role as the main directors of the process, and institutional commitment to their work is crucial. In this context, tutors should receive time and specific formation to allow the evaluation of training as the cornerstone of the new model. New forms of objective summative and training evaluation should be introduced to guarantee that the predefined competences and skills are effectively acquired. The free movement of specialists within Europe is very desirable and implies that training quality must be high and amenable to homologation among the different countries. The Competency Based training in Intensive Care Medicine in Europe program is our main reference for achieving this goal. Scientific societies in turn must impulse and facilitate all those initiatives destined to improve healthcare quality and therefore specialist training. They have the mission of designing strategies and processes that favor training, accreditation and advisory activities with the government authorities. Copyright © 2013 Elsevier España, S.L. y SEMICYUC. All rights reserved.

  18. Interrelationships between romance, life quality, and medical training of female residents.

    Science.gov (United States)

    Wang, Yu-Jung; Hsu, Kan-Lin; Chang, Chin-Sung; Wu, Chih-Hsing

    2012-08-01

    For the past 30 years, there has been a steady increase in the number of female physicians, but the relationship between their romantic lives and their pattern of training has been inadequately reported. This study was designed to investigate the interrelationships between medical training, quality of life, and the attitudes that female residents have toward romance. Of the 106 female medical residents at our medical center in 2009, a total of 78 residents (73.6%) were enrolled for the study. Structured questionnaires (Cronbach α = 0.878), which included questions about female resident quality of life, attitude toward spousal choice, and the impact of programmed professional medical training, were self-administered through an anonymous process. Female residents, especially ward-care specialists, were determined to have excessively long working hours (84.6% > 88 work hours/week), insufficient and irregular sleep (44.9%), and inadequate personal time (73.1% friends, differences in values, and work-related stress. Those presumptive factors influencing romance between the assumed partner being a doctor or a "nondoctor" were significantly different with regard to lack of time (p = 0.002), values (p work-related stress (p life were significantly influenced by the pattern of medical training in female residents. Setting duty-hour limits and initiating a new hobby were determined to be potentially beneficial to their quality of life and attitudes toward romance. Copyright © 2012. Published by Elsevier B.V.

  19. Pediatric fractures – an educational needs assessment of Canadian pediatric emergency medicine residents

    Directory of Open Access Journals (Sweden)

    Dixon AC

    2015-06-01

    Full Text Available Andrew C Dixon Department of Pediatrics, University of Alberta, Edmonton, AB, Canada Objectives: To determine the gaps in knowledge of Canadian pediatric emergency medicine residents with regards to acute fracture identification and management. Due to their predominantly medical prior training, fractures may be an area of weakness requiring a specific curriculum to meet their needs. Methods: A questionnaire was developed examining comfort level and performance on knowledge based questions of trainees in the following areas: interpreting musculoskeletal X-rays; independently managing pediatric fractures, physical examination techniques, applied knowledge of fracture management, and normal development of the bony anatomy. Using modified Dillman technique the instrument was distributed to pediatric emergency medicine residents at seven Canadian sites. Results: Out of 43 potential respondents, 22 (51% responded. Of respondents, mean comfort with X-ray interpretation was 69 (62–76 95% confidence interval [CI] while mean comfort with fracture management was only 53 (45–63 95% CI; mean comfort with physical exam of shoulder 60 (53–68 95% CI and knee 69 (62–76 95% CI was low. Less than half of respondents (47%; 95% CI 26%–69% could accurately identify normal wrist development, correctly manage a supracondylar fracture (39%; 95% CI 20%–61%, or identify a medial epicondyle fracture (44%; 95% CI 24%–66%. Comfort with neurovascular status of the upper (mean 82; 95% CI 75–89 and lower limb (mean 81; 95% CI 74–87 was high. Interpretation: There are significant gaps in knowledge of physical exam techniques, fracture identification and management among pediatric emergency medicine trainees. A change in our current teaching methods is required to meet this need. Keywords: pediatric, fractures, education, radiologic interpretation

  20. Impact of a family medicine resident wellness curriculum: a feasibility study

    Directory of Open Access Journals (Sweden)

    Christine Runyan

    2016-06-01

    Full Text Available Background: Up to 60% of practicing physicians report symptoms of burnout, which often peak during residency. Residency is also a relevant time for habits of self-care and resiliency to be emphasized. A growing literature underscores the importance of this; however, evidence about effective burnout prevention curriculum during residency remains limited. Objectives: The purpose of this project is to evaluate the impact of a new, 1-month wellness curriculum for 12 second-year family medicine residents on burnout, empathy, stress, and self-compassion. Methods: The pilot program, introduced during a new rotation emphasizing competencies around leadership, focused on teaching skills to cultivate mindfulness and self-compassion in order to enhance empathy and reduce stress. Pre-assessments and 3-month follow-up assessments on measures of burnout, empathy, self-compassion, and perceived stress were collected to evaluate the impact of the curriculum. It was hypothesized that this curriculum would enhance empathy and self-compassion as well as reduce stress and burnout among family medicine residents. Results: Descriptive statistics revealed positive trends on the mean scores of all the measures, particularly the Mindfulness Scale of the Self-Compassion Inventory and the Jefferson Empathy Scale. However, the small sample size and lack of sufficient power to detect meaningful differences limited the use of inferential statistics. Conclusions: This feasibility study demonstrates how a residency wellness curriculum can be developed, implemented, and evaluated with promising results, including high participant satisfaction.

  1. Internal Medicine residents use heuristics to estimate disease probability

    OpenAIRE

    Phang, Sen Han; Ravani, Pietro; Schaefer, Jeffrey; Wright, Bruce; McLaughlin, Kevin

    2015-01-01

    Background: Training in Bayesian reasoning may have limited impact on accuracy of probability estimates. In this study, our goal was to explore whether residents previously exposed to Bayesian reasoning use heuristics rather than Bayesian reasoning to estimate disease probabilities. We predicted that if residents use heuristics then post-test probability estimates would be increased by non-discriminating clinical features or a high anchor for a target condition. Method: We randomized 55 In...

  2. The current and ideal state of mental health training: pediatric resident perspectives.

    Science.gov (United States)

    Hampton, Elisa; Richardson, Joshua E; Bostwick, Susan; Ward, Mary J; Green, Cori

    2015-01-01

    PHENOMENON: Mental health (MH) problems are prevalent in the pediatric population, and in a setting of limited resources, pediatricians need to provide MH care in the primary medical home yet are uncomfortable doing so citing a lack of training during residency as one barrier. The purpose of this study is to describe pediatric residents' experiences and perspectives on the current and ideal states of MH training and ideas for curriculum development to bridge this gap. A qualitative study using focus groups of pediatric residents from an urban academic medical center was performed. Audio recordings were transcribed and analyzed using a grounded theory approach. Twenty-six residents participated in three focus groups, which is when thematic saturation was achieved. The team generated five major themes: capabilities, comfort, organizational capacity, coping, and education. Residents expressed uncertainty at every step of an MH visit. Internal barriers identified included low levels of comfort and negative emotional responses. External barriers included a lack of MH resources and mentorship in MH care, or an inadequate organizational capacity. These internal and external barriers resulted in a lack of perceived capability in handling MH issues. In response, residents reported inadequate coping strategies, such as ignoring MH concerns. To build knowledge and skills, residents prefer educational modalities including didactics, experiential learning through collaborations with MH specialists, and tools built into patient care flow. Insights: Pediatric residency programs need to evolve in order to improve resident training in MH care. The skills and knowledge requested by residents parallel the American Academy of Pediatrics statement on MH competencies. Models of collaborative care provide similar modalities of learning requested by residents. These national efforts have not been operationalized in training programs yet may be useful for curriculum development and

  3. Social media in the emergency medicine residency curriculum: social media responses to the residents' perspective article.

    Science.gov (United States)

    Hayes, Bryan D; Kobner, Scott; Trueger, N Seth; Yiu, Stella; Lin, Michelle

    2015-05-01

    In July to August 2014, Annals of Emergency Medicine continued a collaboration with an academic Web site, Academic Life in Emergency Medicine (ALiEM), to host an online discussion session featuring the 2014 Annals Residents' Perspective article "Integration of Social Media in Emergency Medicine Residency Curriculum" by Scott et al. The objective was to describe a 14-day worldwide clinician dialogue about evidence, opinions, and early relevant innovations revolving around the featured article and made possible by the immediacy of social media technologies. Six online facilitators hosted the multimodal discussion on the ALiEM Web site, Twitter, and YouTube, which featured 3 preselected questions. Engagement was tracked through various Web analytic tools, and themes were identified by content curation. The dialogue resulted in 1,222 unique page views from 325 cities in 32 countries on the ALiEM Web site, 569,403 Twitter impressions, and 120 views of the video interview with the authors. Five major themes we identified in the discussion included curriculum design, pedagogy, and learning theory; digital curation skills of the 21st-century emergency medicine practitioner; engagement challenges; proposed solutions; and best practice examples. The immediacy of social media technologies provides clinicians the unique opportunity to engage a worldwide audience within a relatively short time frame. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  4. "Taking Training to the Next Level": The American College of Surgeons Committee on Residency Training Survey.

    Science.gov (United States)

    Damewood, Richard B; Blair, Patrice Gabler; Park, Yoon Soo; Lupi, Linda K; Newman, Rachel Williams; Sachdeva, Ajit K

    The American College of Surgeons (ACS) appointed a committee of leaders from the ACS, Association of Program Directors in Surgery, Accreditation Council for Graduate Medical Education, and American Board of Surgery to define key challenges facing surgery resident training programs and to explore solutions. The committee wanted to solicit the perspectives of surgery resident program directors (PDs) given their pivotal role in residency training. Two surveys were developed, pilot tested, and administered to PDs following Institutional Review Board approval. PDs from 247 Accreditation Council for Graduate Medical Education-accredited general surgery programs were randomized to receive 1 of the 2 surveys. Bias analyses were conducted, and adjusted Pearson χ 2 tests were used to test for differences in response patterns by program type and size. All accredited general surgery programs in the United States were included in the sampling frame of the survey; 10 programs with initial or withdrawn accreditation were excluded from the sampling frame. A total of 135 PDs responded, resulting in a 54.7% response rate (Survey A: n = 67 and Survey B: n = 68). The respondent sample was determined to be representative of program type and size. Nearly 52% of PD responses were from university-based programs, and 41% had over 6 residents per graduating cohort. More than 61% of PDs reported that, compared to 10 years ago, both entering and graduating residents are less prepared in technical skills. PDs expressed significant concerns regarding the effect of duty-hour restrictions on the overall preparation of graduating residents (61%) and quality of patient care (57%). The current 5-year training structure was viewed as needing a significant or extensive increase in opportunities for resident autonomy (63%), and the greatest barriers to resident autonomy were viewed to be patient preferences not to be cared for by residents (68%), liability concerns (68%), and Centers for Medicare and

  5. Otorhinolaryngology residency in Spain: training satisfaction, working environment and conditions.

    Science.gov (United States)

    Oker, N; Alotaibi, N H; Herman, P; Bernal-Sprekelsen, M; Albers, A E

    2016-06-01

    Europe-wide efforts are being initiated to define quality standards and harmonize Otolaryngology, Head and Neck Surgery (ORL-HNS)-specialty-training by creating an European board examination. However, differences within and between countries remain and are underinvestigated making comparisons and further improvement more difficult. The study aimed at assessing quality of training, satisfaction and quality of life of residents and recent ORL-HNS specialists in Spain and to trace similarities and differences to France and Germany administering anonymous online-questionnaire to ORL-HNS-residents and recent specialists. 146 questionnaires were returned with answers of 75.6 % of residents, a mean age of 30 years and a female to male ratio of 1.46:1. The global satisfaction of training was high as 76 % would choose the same ENT training again, 86 % confirmed that responsibilities which were given to them were adapted to their level of training and 97 % felt well considered in their department. Ninety-two confirmed that helpful seniors contributed to a good work environment (75 %) and to a good organization within the department (69 %). The respondents spent on average 8.8 h per day at the hospital and covered on average 4.8 night duties or week-end shifts per month with mostly no post-day off (86 %). Seventy-four percent participated regularly at complementary training sessions. Research work was supported and guided in 59 %. This study is the first one, to our best of knowledge, to assess the ORL-HNS-training in Spain and to trace parallelisms and differences to other European countries, such as France and Germany. The satisfaction of training and supervision was high in Spain, but there are still efforts to make concerning resident's quality of life. Compared to France and Germany, satisfaction with ORL-HNS-training and the support and guidance provided by seniors was similar. Work conditions were comparable to those in France. Motivation, teaching and

  6. Training in Emergency Obstetrics: A Needs Assessment of U.S. Emergency Medicine Program Directors

    Directory of Open Access Journals (Sweden)

    Daniel W. Robinson

    2017-12-01

    Full Text Available Introduction Obstetrical emergencies are a high-risk yet infrequent occurrence in the emergency department. While U.S. emergency medicine (EM residency graduates are required to perform 10 low-risk normal spontaneous vaginal deliveries, little is known about how residencies prepare residents to manage obstetrical emergencies. We sought to profile the current obstetrical training curricula through a survey of U.S. training programs. Methods We sent a web-based survey covering the four most common obstetrical emergencies (pre-eclampsia/eclampsia, postpartum hemorrhage (PPH, shoulder dystocia, and breech presentation through email invitations to all program directors (PD of U.S. EM residency programs. The survey focused on curricular details as well as the comfort level of the PDs in the preparation of their graduating residents to treat obstetrical emergencies and normal vaginal deliveries. Results Our survey had a 55% return rate (n=105/191. Of the residencies responding, 75% were in the academic setting, 20.2% community, 65% urban, and 29.8% suburban, and the obstetrical curricula were 2–4 weeks long occurring in post-graduate year one. The most common teaching method was didactics (84.1–98.1%, followed by oral cases for pre-eclampsia (48% and PPH (37.2%, and homemade simulation for shoulder dystocia (37.5% and breech delivery (33.3%. The PDs’ comfort about residency graduate skills was highest for normal spontaneous vaginal delivery, pre-eclampsia, and PPH. PDs were not as comfortable about their graduates’ skill in handling shoulder dystocia or breech delivery. Conclusion Our survey found that PDs are less comfortable in their graduates’ ability to perform non-routine emergency obstetrical procedures.

  7. Effectiveness of a Core-Competency-based Program on Residents' Learning and Experience.

    Science.gov (United States)

    Charles, Lesley; Triscott, Jean; Dobbs, Bonnie; Tian, Peter George; Babenko, Oksana

    2016-06-01

    The Care of the Elderly (COE) Diploma Program is a six-to-twelve-month enhanced skills program taken after two years of core residency training in Family Medicine. In 2010, we developed and implemented a core-competency-based COE Diploma program (CC), in lieu of one based on learning objectives (LO). This study assessed the effectiveness of the core-competency-based program on residents' learning and their training experience as compared to residents trained using learning objectives. The data from the 2007-2013 COE residents were used in the study, with nine and eight residents trained in the LO and CC programs, respectively. Residents' learning was measured using preceptors' evaluations of residents' skills/abilities throughout the program (118 evaluations in total). Residents' rating of training experience was measured using the Graduate's Questionnaire which residents completed after graduation. For residents' learning, overall, there was no significant difference between the two programs. However, when examined as a function of the four CanMEDS roles, there were significant increases in the CC residents' scores for two of the CanMEDS roles: Communicator/Collaborator/Manager and Scholar compared to residents in the LO program. With respect to residents' training experience, seven out of ten program components were rated by the CC residents higher than by the LO residents. The implementation of a COE CC program appears to facilitate resident learning and training experience.

  8. Education and training circumstances of radiology for residents in qualified hospitals

    International Nuclear Information System (INIS)

    Imamura, Keiko; Nakajima, Yasuo; Kiba, Ritsuko; Mizunuma, Kimiyoshi; Ida, Masahiro; Kawabuchi, Koichi

    2005-01-01

    This report is a summary of investigations on the title from the aspect of human resources. Data were collected from databases of websites of Residency Electronic Information System, www.reisjp.org, and Foundation for Promotion of Medical training, www.pmet.org.jp, and from Hospital List (February, 2003) where Japanese radiology physicians were actually working. Investigations were performed on: qualification criteria of hospitals for training, their bed number, number of residents to be admitted, number of physicians and supervising doctors, presence/absence of independent radiology department, number of physicians, supervising doctors and expert physicians in the department. The number rate of physicians in the department is identified to be 64.7% and 84.3% of general and university hospitals, respectively; number of residents to be admitted per one supervisor in the university hospitals is 1.5-2.6 times as high as that in general hospitals; and about 1/4 of residents to be admitted may be in circumstances poor for radiology training. (author)

  9. The effect of dual accreditation on family medicine residency programs.

    Science.gov (United States)

    Mims, Lisa D; Bressler, Lindsey C; Wannamaker, Louise R; Carek, Peter J

    2015-04-01

    In 1985, the American Osteopathic Association (AOA) Board of Trustees agreed to allow residency programs to become dually accredited by the AOA and Accreditation Council for Graduate Medical Education (ACGME). Despite the increase in such programs, there has been minimal research comparing these programs to exclusively ACGME-accredited residencies. This study examines the association between dual accreditation and suggested markers of quality. Standard characteristics such as regional location, program structure (community or university based), postgraduate year one (PGY-1) positions offered, and salary (PGY-1) were obtained for each residency program. In addition, the faculty to resident ratio in the family medicine clinic and the number of half days residents spent in the clinic each week were recorded. Initial Match rates and pass rates of new graduates on the ABFM examination from 2009 to 2013 were also obtained. Variables were analyzed using chi-square and Student's t test. Logistic regression models were then created to predict a program's 5-year aggregate initial Match rate and Board pass rate in the top tertile as compared to the lowest tertile. Dual accreditation was obtained by 117 (27.0%) of programs. Initial analyses revealed associations between dually accredited programs and mean year of initial ACGME program accreditation, regional location, program structure, tracks, and alternative medicine curriculum. When evaluated in logistic regression, dual accreditation status was not associated with Match rates or ABFM pass rates. By examining suggested markers of program quality for dually accredited programs in comparison to ACGME-only accredited programs, this study successfully established both differences and similarities among the two types.

  10. Internal Medicine Residents' Beliefs, Attitudes, and Experiences Relating to Palliative Care: A Qualitative Study.

    Science.gov (United States)

    Kawaguchi, S; Mirza, R; Nissim, R; Ridley, J

    2017-05-01

    Internal medicine residents are frequently called upon to provide palliative care to hospitalized patients, but report feeling unprepared to do so effectively. Curricular development to enhance residents' palliative care skills and competencies requires an understanding of current beliefs, attitudes and learning priorities. We conducted a qualitative study consisting of semi-structured interviews with ten internal medicine residents to explore their understanding of and experiences with palliative care. All of the residents interviewed had a sound theoretical understanding of palliative care, but faced many challenges in being able to provide care in practice. The challenges described by residents were system-related, patient-related and provider-related. They identified several priority areas for further learning, and discussed ways in which their current education in palliative care could be enhanced. Our findings provide important insights to guide curricular development for internal medicine trainees. The top five learning priorities in palliative care that residents identified in our study were: 1) knowing how and when to initiate a palliative approach, 2) improving communication skills, 3) improving symptom management skills, 4) identifying available resources, and 5) understanding the importance of palliative care. Residents felt that their education in palliative care could be improved by having a mandatory rotation in palliative care, more frequent didactic teaching sessions, more case-based teaching from palliative care providers, opportunities to be directly observed, and increased support from palliative care providers after-hours.

  11. Social media beliefs and usage among family medicine residents and practicing family physicians.

    Science.gov (United States)

    Klee, David; Covey, Carlton; Zhong, Laura

    2015-03-01

    Incorporation of social media (SM) use in medicine is gaining support. The Internet is now a popular medium for people to solicit medical information. Usage of social networks, such as Facebook and Twitter, is growing daily and provides physicians with nearly instantaneous access to large populations for both marketing and patient education. The benefits are myriad, but so are the inherent risks. We investigated the role providers' age and medical experience played in their beliefs and use of SM in medicine. Using multiple state-wide and national databases, we assessed social media use by family medicine residents, faculty, and practicing family physicians with a 24-question online survey. Descriptive data is compared by age and level of medical experience. A total of 61 family medicine residents and 192 practicing family physicians responded. There is a trend toward higher SM utilization in the younger cohort, with 90% of resident respondents reporting using SM, half of them daily. A total of 64% of family physician respondents over the age of 45 have a SM account. An equal percentage of senior physicians use SM daily or not at all. Practicing physicians, more than residents, agree that SM can be beneficial in patient care. The vast majority of residents and physicians polled believe that SM should be taught early in medical education. The high utilization of SM by younger providers, high prevalence of patient use of the Internet, and the countless beneficial opportunities SM offers should be catalysts to drive curriculum development and early implementation in medical education. This curriculum should focus around four pillars: professional standards for SM use, SM clinical practice integration, professional networking, and research.

  12. Step-by-step phacoemulsification training program for ophthalmology residents

    Directory of Open Access Journals (Sweden)

    Wang Yulan

    2013-01-01

    Full Text Available Aims: The aim was to analyze the learning curve of phacoemulsification (phaco performed by residents without experience in performing extra-capsular cataract extraction (ECCE in a step-by-step training program (SBSTP. Materials and Methods: Consecutive surgical records of phaco performed from March 2009 to Sept 2011 by four residents without previous ECCE experience were retrospectively reviewed. The completion rate of the first 30 procedures by each resident was calculated. The main intraoperative phaco parameter records for the first 30 surgeries by each resident were compared with those for their last 30 surgeries. Intraoperative complications in the residents′ procedures were also recorded and analyzed. Results: A total of 1013 surgeries were performed by residents. The completion rate for the first 30 phaco procedures was 79.2 μ 5.8%. The main reasons for halting the procedure were as follows: Anterior capsule tear, inability to crack the nucleus, and posterior capsular rupture during phaco or cortex removal. Cumulative dissipated energy of phaco power used during the surgeries was significantly less in the last 30 cases compared with the first 30 cases (30.10 μ 17.58 vs. 55.41 μ 37.59, P = 0.021. Posterior capsular rupture rate was 2.5 μ 1.2% in total (10.8 μ 4.2% in the first 30 cases and 1.7 μ 1.9% in the last 30 cases, P = 0.008; a statistically significant difference. Conclusion:The step-by-step training program might be a necessary process for a resident to transit from dependence to a self-supported operator. It is also an essential middle step between wet lab training to performing the entire phaco procedure on the patient both effectively and safely.

  13. Resident Dyads Providing Transition Care to Adolescents and Young Adults With Chronic Illnesses and Neurodevelopmental Disabilities.

    Science.gov (United States)

    Chung, Richard J; Jasien, Joan; Maslow, Gary R

    2017-04-01

    Youth with special health care needs often experience difficulty transitioning from pediatric to adult care. These difficulties may derive in part from lack of physician training in transition care and the challenges health care providers experience establishing interdisciplinary partnerships to support these patients. This educational innovation sought to improve pediatrics and adult medicine residents' interdisciplinary communication and collaboration. Residents from pediatrics, medicine-pediatrics, and internal medicine training programs participated in a transitions clinic for patients with chronic health conditions aged 16 to 26 years. Residents attended 1 to 4 half-day clinic sessions during 1-month ambulatory rotations. Pediatrics/adult medicine resident dyads collaboratively performed psychosocial and medical transition consultations that addressed health care navigation, self-care, and education and vocation topics. Two to 3 attending physicians supervised each clinic session (4 hours) while concurrently seeing patients. Residents completed a preclinic survey about baseline attitudes and experiences, and a postclinic survey about their transitions clinic experiences, changes in attitudes, and transition care preparedness. A total of 46 residents (100% of those eligible) participated in the clinic and completed the preclinic survey, and 25 (54%) completed the postclinic survey. A majority of respondents to the postclinic survey reported positive experiences. Residents in both pediatrics and internal medicine programs reported improved preparedness for providing transition care to patients with chronic health conditions and communicating effectively with colleagues in other disciplines. A dyadic model of collaborative transition care training was positively received and yielded improvements in immediate self-assessed transition care preparedness.

  14. Familiarity with Long-acting Reversible Contraceptives among Obstetrics and Gynecology, Family Medicine, and Pediatrics Residents: Results of a 2015 National Survey and Implications for Contraceptive Provision for Adolescents.

    Science.gov (United States)

    Davis, Susan A; Braykov, Nikolay P; Lathrop, Eva; Haddad, Lisa B

    2018-02-01

    To assess familiarity with long-acting reversible contraceptives (LARC) among current obstetrics and gynecology (OB/GYN), family medicine (FM), and pediatrics senior residents in the United States. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We selected 156 OB/GYN, FM, and pediatrics residency programs using the American Medical Association Freida database. Senior residents completed a survey addressing any training they had received on LARC, and rated their comfort level counseling about and inserting LARC. Residents rated their likelihood of recommending LARC to an adolescent, nulliparous patient, and indicated whether they would like additional training on LARC. Descriptive and analytic statistics were generated using R statistical software (The R Project for Statistical Computing; https://www.r-project.org). The survey was completed by 326 of 1,583 residents (20.6% response rate); at least 1 resident completed the survey at 105 (67.3%) of the residency programs contacted. Most programs (84.8%) provided some training on LARC. Residents in OB/GYN programs were comfortable counseling about and inserting contraceptive implants (97%, 83%), copper intrauterine devices (IUDs; 100%, 86%), and levonorgestrel (LNG) IUDs (100%, 86%). In FM programs, fewer residents were comfortable counseling about and inserting contraceptive implants (71%, 47%), copper IUDs (68%, 21%), and LNG IUDs (79%, 18%). Residents in pediatrics programs had low comfort levels counseling about contraceptive implants (14%), copper IUDs (14%), and LNG IUDs (25%); no pediatrics residents were comfortable inserting LARC. OB/GYN residents were significantly more likely to recommend a LARC to an adolescent, nulliparous patient (P = .019). Most pediatric and FM residents desired additional training on LARC (82.7% and 60.7%, respectively). This study shows that knowledge gaps exist regarding LARC among FM and pediatrics residents. Copyright © 2017 North American Society for

  15. Feasibility of Spanish-language acquisition for acute medical care providers: novel curriculum for emergency medicine residencies.

    Science.gov (United States)

    Grall, Kristi H; Panchal, Ashish R; Chuffe, Eliud; Stoneking, Lisa R

    2016-01-01

    Language and cultural barriers are detriments to quality health care. In acute medical settings, these barriers are more pronounced, which can lead to poor patient outcomes. We implemented a longitudinal Spanish-language immersion curriculum for emergency medicine (EM) resident physicians. This curriculum includes language and cultural instruction, and is integrated into the weekly EM didactic conference, longitudinal over the entire 3-year residency program. Language proficiency was assessed at baseline and annually on the Interagency Language Roundtable (ILR) scale, via an oral exam conducted by the same trained examiner each time. The objective of the curriculum was improvement of resident language skills to ILR level 1+ by year 3. Significance was evaluated through repeated-measures analysis of variance. The curriculum was launched in July 2010 and followed through June 2012 (n=16). After 1 year, 38% had improved over one ILR level, with 50% achieving ILR 1+ or above. After year 2, 100% had improved over one level, with 90% achieving the objective level of ILR 1+. Mean ILR improved significantly from baseline, year 1, and year 2 (F=55, df =1; Planguage skills in EM residents. The curriculum improved EM-resident language proficiency above the goal in just 2 years. Further studies will focus on the effect of language acquisition on patient care in acute settings.

  16. Saudi Internal Medicine Residents׳ Perceptions of the Objective Structured Clinical Examination as a Formative Assessment Tool

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    Salwa Alaidarous

    2016-12-01

    Full Text Available The Saudi Commission for Health Specialties first implemented the Objective Structured Clinical Examinations (OSCE as part of the final year Internal Medicine clerkship exam during the 2007–2008 academic year. This study evaluated Internal Medicine residents׳ overall perceptions of the OSCE as a formative assessment tool. It focused on residents׳ perceptions of the OSCE stations׳ attributes, determined the acceptability of the process, and provided feedback to enhance further development of the assessment tool. The main objective was to assess Internal Medicine resident test-takers׳ perceptions and acceptance of the OSCE, and to identify its strengths and weaknesses through their feedback. Sixty six residents were involved in the studied administered on November 8th 2012 at King Abdulaziz University Hospital in Jeddah, Kingdom of Saudi Arabia. Overall, resident׳s evaluation of the OSCE was favorable and encouraging. To this end, we recommend that formative assessment opportunities using the OSCE for providing feedback to students should be included in the curriculum, and continuing refinement and localized adaptation of OSCEs in use should be pursued by course directors and assessment personnel.

  17. Surgical Residency Training in Developing Countries: West African College of Surgeons as a Case Study.

    Science.gov (United States)

    Ajao, Oluwole Gbolagunte; Alao, Adekola

    2016-01-01

    In 1904, William Halsted introduced the present model of surgical residency program which has been adopted worldwide. In some developing countries, where surgical residency training programs are new, some colleges have introduced innovations to the Halsted's original concept of surgical residency training. These include 1) primary examination, 2) rural surgical posting, and 3) submission of dissertation for final certification. Our information was gathered from the publications on West African College of Surgeons' (WACS) curriculum of the medical schools, faculty papers of medical schools, and findings from committees of medical schools. Verbal information was also gathered via interviews from members of the WACS. Additionally, our personal experience as members and examiners of the college are included herein. We then noted the differences between surgical residency training programs in the developed countries and that of developing countries. The innovations introduced into the residency training programs in the developing countries are mainly due to the emphasis placed on paper qualifications and degrees instead of performance. We conclude that the innovations introduced into surgical residency training programs in developing countries are the result of the misconception of what surgical residency training programs entail. Published by Elsevier Inc.

  18. Relationship of residency program characteristics with pass rate of the American Board of Internal Medicine certifying exam

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    Amporn Atsawarungruangkit

    2015-09-01

    Full Text Available Objectives: To evaluate the relationship between the pass rate of the American Board of Internal Medicine (ABIM certifying exam and the characteristics of residency programs. Methods: The study used a retrospective, cross-sectional design with publicly available data from the ABIM and the Fellowship and Residency Electronic Interactive Database. All categorical residency programs with reported pass rates were included. Using univariate and multivariate, linear regression analyses, I analyzed how 69 factors (e.g., location, general information, number of faculty and trainees, work schedule, educational environment are related to the pass rate. Results: Of 371 programs, only one region had a significantly different pass rate from the other regions; however, as no other characteristics were reported in this region, I excluded program location from further analysis. In the multivariate analysis, pass rate was significantly associated with four program characteristics: ratio of full-time equivalent paid faculty to positions, percentage of osteopathic doctors, formal mentoring program, and on-site child care (OCC. Numerous factors were not associated at all, including minimum exam scores, salary, vacation days, and average hours per week. Conclusions: As shown through the ratio of full-time equivalent paid faculty to positions and whether there was a formal mentoring program, a highly supervised training experience was strongly associated with the pass rate. In contrast, percentage of osteopathic doctors was inversely related to the pass rate. Programs with OCC significantly outperformed programs without OCC. This study suggested that enhancing supervision of training programs and offering parental support may help attract and produce competitive residents.

  19. Residents' training to retinal photocoagulation: virtual reality compared to conventional apprenticeship

    Science.gov (United States)

    Peugnet, Frederic; Dubois, Patrick; Rouland, Jean-Francois

    1998-06-01

    Virtual reality is one of these recent technologies which can provide an efficient help in the field of surgical apprenticeship. We achieved an original training simulator for retinal photocoagulation destined to the residents of the ophthalmological department. This paper describes the comparison between this new training tool and the conventional practice. Two groups of residents, randomly selected, were trained exclusively by one of these methods. These two groups were under the responsibility of two distinct experts. A final evaluation was made by a third and different expert, ignoring the training mode practiced by each of the residents. The study lasted six months. The results show that this new training mode is at least as efficient as the current one in terms of elapsed time and efficiency. It may even reduce the training duration. These results confirm that a pedagogical simulator could give a new approach in the medical teaching, particularly in its management. Such a device may solve the problems of practitioner's lack of disponibility and of patients' safety and comfort during a conventional training. Furthermore, it could bring an objective way to value the students; practical ability. On the other hand, this preliminary study emphasizes the difficulties in introducing a new modality in a traditional teaching environment.

  20. Residency Training: Work engagement during neurology training.

    Science.gov (United States)

    Zis, Panagiotis; Anagnostopoulos, Fotios; Artemiadis, Artemios K

    2016-08-02

    Work engagement, defined as a positive, fulfilling, work-related state of mind that is characterized by vigor, dedication, and absorption, can ameliorate patient care and reduce medical errors. The purpose of this cross-sectional study was to investigate work engagement among neurology residents in the region of Attica, Greece. In total, 113 residents participated in this study. Demographic and work-related characteristics, as well as emotional exhaustion and personality traits (neuroticism), were examined via an anonymous questionnaire. Work engagement was measured by the Utrecht Work Engagement Scale. The study sample had a mean age of 34.6 ± 3.6 years, ranging from 26 to 45 years. Sixty-two (54.9%) participants were women and 45 (39.8%) were married. After adjusting for sex, emotional exhaustion, and neuroticism, the main factors associated with work engagement were autonomy and chances for professional development. Providing more chances for trainees' professional development as well as allowing for and supporting greater job autonomy may improve work engagement during neurology training. © 2016 American Academy of Neurology.

  1. General medicine advanced training: lessons from the John Hunter training programme.

    Science.gov (United States)

    Jackel, D; Attia, J; Pickles, R

    2014-03-01

    Recent years have seen a rapid growth in the number of advanced trainees pursuing general medicine as a specialty. This reflects an awareness of the need for broader training experiences to equip future consultant physicians with the skills to manage the healthcare challenges arising from the demographic trends of ageing and increasing comorbidity. The John Hunter Hospital training programme in general medicine has several characteristics that have led to the success in producing general physicians prepared for these challenges. These include support from a core group of committed general physicians, an appropriate and sustainable funding model, flexibility with a focus on genuine training and developing awareness of a systems approach, and strong links with rural practice. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

  2. Effectiveness of different memory training programs on improving hyperphagic behaviors of residents with dementia: a longitudinal single-blind study

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    Kao CC

    2016-05-01

    Full Text Available Chieh-Chun Kao,1,2 Li-Chan Lin,3 Shiao-Chi Wu,4 Ker-Neng Lin,5,6 Ching-Kuan Liu7,8 1Department of Nursing, National Yang-Ming University, Taipei, 2Department of Nursing, Ching Kuo Institute of Management and Health, Keelung, 3Institute of Clinical Nursing, 4Institute of Health and Welfare Policy, National Yang-Ming University, 5Neurological Institute, Taipei Veterans General Hospital, Taipei, 6Department of Psychology, Soochow University, Taipei, Taiwan; 7Department of Neurology, Kaohsiung Medical University Hospital, 8Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan Background: Hyperphagia increases eating-associated risks for people with dementia and distress for caregivers. The purpose of this study was to compare the long-term effectiveness of spaced retrieval (SR training and SR training combined with Montessori activities (SR + M for improving hyperphagic behaviors of special care unit residents with dementia. Methods: The study enrolled patients with dementia suffering from hyperphagia resident in eight institutions and used a cluster-randomized single-blind design, with 46 participants in the SR group, 49 in the SR + M group, and 45 participants in the control group. For these three groups, trained research assistants collected baseline data on hyperphagic behavior, pica, changes in eating habits, short meal frequency, and distress to caregivers. The SR and SR + M groups underwent memory training over a 6-week training period (30 sessions, and a generalized estimating equation was used to compare data of all the three groups of subjects obtained immediately after the training period and at follow-ups 1 month, 3 months, and 6 months later. Results: Results showed that the hyperphagic and pica behaviors of both the SR and SR + M groups were significantly improved (P<0.001 and that the effect lasted for 3 months after training. The improvement of fast eating was

  3. Benefits and Challenges of Developing a Customized Rubric for Curricular Review of a Residency Program in Laboratory Animal Medicine.

    Science.gov (United States)

    Whitcomb, Tiffany L; Wilson, Ronald P

    Rigorous curricular review of post-graduate veterinary medical residency programs is in the best interest of program directors in light of the requirements and needs of specialty colleges, graduate school administrations, and other stakeholders including prospective students and employers. Although minimum standards for training are typically provided by specialty colleges, mechanisms for evaluation are left to the discretion of program directors. The paucity of information available describing best practices for curricular assessment of veterinary medical specialty training programs makes resources from other medical fields essential to informing the assessment process. Here we describe the development of a rubric used to evaluate courses in a 3-year American College of Laboratory Animal Medicine (ACLAM)-recognized residency training program culminating in a Master of Science degree. This rubric, based on examples from medical education and other fields of graduate study, provided transparent criteria for evaluation that were consistent with stakeholder needs and institutional initiatives. However, its use caused delays in the curricular review process as two significant obstacles to refinement were brought to light: variation in formal education in curriculum design and significant differences in teaching philosophies among faculty. The evaluation process was able to move forward after institutional resources were used to provide faculty development in curriculum design. The use of a customized rubric is recommended as a best practice for curricular refinement for residency programs because it results in transparency of the review process and can reveal obstacles to change that would otherwise remain unaddressed.

  4. The Effect of Elective Rotations on the Self-assessment Examination Results of Physical Medicine and Rehabilitation Residents: Implications for Minimizing Educational Resource Disparities in Taiwan.

    Science.gov (United States)

    Lien, I-Nan; Wu, Pei-Shen; Wang, Tyng-Guey; Chen, Wen-Shiang; Lew, Henry L

    2017-08-01

    The aims of the study were (1) to assess whether a knowledge disparity existed between physical medicine and rehabilitation residents from community hospitals versus those from medical centers, before the introduction of short-term elective training at the end of 2008 and (2), if such disparity existed, to determine whether 1-month short-term elective training was associated with minimizing such disparity, as reflected in the self-assessment examination scores. Self-assessment examination scores from 2007-2016 were analyzed in each of the following three topics: (a) cardiac rehabilitation, (b) pulmonary rehabilitation, and (c) orthotics. Student's t tests were used to identify score discrepancies between both groups. (1) At baseline (2007-2008), trainees from community hospitals scored lower in all three topics (P < 0.05). (2) After the short-term elective training, follow-up comparisons showed no differences in either cardiac or pulmonary rehabilitation for 2009-2016. Regarding orthotics, trainees from both groups showed no significant differences for 2009-2010 and 2011-2012. Interestingly, for 2013-2014 and 2015-2016, trainees from medical centers scored higher again, but only in orthotics. (1) In 2007-2008, a knowledge disparity existed between physical medicine and rehabilitation residents from community hospitals and medical centers in Taiwan. (2) Short-term elective training was associated with minimizing such disparity from 2009-2016, especially in cardiac and pulmonary rehabilitation.

  5. Social worker assessment of bad news delivery by emergency medicine residents: a novel direct-observation milestone assessment.

    Science.gov (United States)

    Min, Alice Ann; Spear-Ellinwood, Karen; Berman, Melissa; Nisson, Peyton; Rhodes, Suzanne Michelle

    2016-09-01

    The skill of delivering bad news is difficult to teach and evaluate. Residents may practice in simulated settings; however, this may not translate to confidence or competence during real experiences. We investigated the acceptability and feasibility of social workers as evaluators of residents' delivery of bad news during patient encounters, and assessed the attitudes of both groups regarding this process. From August 2013 to June 2014, emergency medicine residents completed self-assessments after delivering bad news. Social workers completed evaluations after observing these conversations. The Assessment tools were designed by modifying the global Breaking Bad News Assessment Scale. Residents and social workers completed post-study surveys. 37 evaluations were received, 20 completed by social workers and 17 resident self-evaluations. Social workers reported discussing plans with residents prior to conversations 90 % of the time (18/20, 95 % CI 64.5, 97.8). Social workers who had previously observed the resident delivering bad news reported that the resident was more skilled on subsequent encounters 90 % of the time (95 % CI 42.2, 99). Both social workers and residents felt that prior training or experience was important. First-year residents valued advice from social workers less than advice from attending physicians, whereas more experienced residents perceived advice from social workers to be equivalent with that of attending physicians (40 versus 2.9 %, p = 0.002). Social worker assessment of residents' abilities to deliver bad news is feasible and acceptable to both groups. This formalized self-assessment and evaluation process highlights the importance of social workers' involvement in delivery of bad news, and the teaching of this skill. This method may also be used as direct-observation for resident milestone assessment.

  6. American College of Radiology In-Training Examination for Residents in Radiation Oncology (2004-2007)

    International Nuclear Information System (INIS)

    Paulino, Arnold C.; Kurtz, Elizabeth

    2008-01-01

    Purpose: To review the results of the recent American College of Radiology (ACR) in-training examinations in radiation oncology and to provide information regarding the examination changes in recent years. Methods and Materials: A retrospective review of the 2004 to 2007 ACR in-training examination was undertaken. Results: The number of residents taking the in-training examination increased from 2004 to 2007, compatible with the increase in the number of radiation oncology residents in the United States and Canada. The number of questions decreased from approximately 510 in 2004 and 2005, to 405 in 2006 and 360 in 2007, most of these changes were in the clinical oncology section. Although the in-training examination showed construct validity with resident performance improving with each year of additional clinical oncology training, it did so only until Level 3 for biology and physics. Several changes have been made to the examination process, including allowing residents to keep the examination booklet for self-study, posting of the answer key and rationales to questions on the ACR Website, and providing hard copies to residency training directors. In addition, all questions are now A type or multiple choice questions with one best answer, similar to the American Board of Radiology written examination for radiation oncology. Conclusion: Several efforts by the ACR have been made in recent years to make the examination an educational tool for radiation oncology residents and residency directors

  7. Effects of adding a new PCMH block rotation and resident team to existing longitudinal training within a certified PCMH: primary care residents’ attitudes, knowledge, and experience

    Directory of Open Access Journals (Sweden)

    Anandarajah G

    2016-08-01

    tasks than those of comparison PGY3s. More intervention PGY3s rated themselves “extremely prepared” to implement PCMH than comparison PGY3s; however, most self-rated “somewhat prepared”. Their reflections demonstrated deeper understanding of PCMH implementation and challenges than comparison PGY3s but inadequate experience to directly see the results of successful solutions. Rotation evaluations from PGY1, PGY2, and PGY3s revealed strengths and several areas for improvement. Conclusion: Adding one 4-week block rotation to existing longitudinal training appears to improve residents’ PCMH knowledge, skills, and experience from “basic” to “intermediate”. However, this training level appears inadequate for PCMH leadership or for teaching junior learners. Further study is needed to determine the optimum training for different settings. Keywords: primary care, new models of healthcare, curriculum, family medicine, population health, residency education

  8. OB/GYN boot cAMP using high-fidelity human simulators: enhancing residents' perceived competency, confidence in taking a leadership role, and stress hardiness.

    Science.gov (United States)

    Pliego, Jose F; Wehbe-Janek, Hania; Rajab, M Hasan; Browning, Jeff L; Fothergill, Russell E

    2008-01-01

    To evaluate the effectiveness of an obstetrical and gynecologic (Ob/Gyn) Boot Camp simulation training on perceived technical competency, confidence in a leadership role, and stress hardiness of resident training. We conducted a prospective pilot study on the effectiveness of an Ob/Gyn Boot Camp on resident training. Residents participated in an intensive immersion in clinical simulation of common obstetrical emergencies including shoulder dystocia, neonatal resuscitation, postpartum hemorrhage, and ruptured ectopic pregnancy. After the training, residents completed a Web-based survey on their perceptions of how the Ob/Gyn Boot Camp affected their 1) technical competency in the assessment and management of their patients, 2) confidence in taking a leadership role, and 3) stress hardiness. Residents rated their perceptions on a Likert scale of 1 to 5, 1 = poor to 5 = excellent. Twenty-three (14 Ob/Gyn and 9 family medicine) residents participated in this pilot study. Eighteen (78%) residents completed the online survey; 4 Ob/Gyn and 1 family medicine resident did not complete the survey. The residents reported that the simulation training stimulated an interest in learning key skills for obstetrical and gynecologic emergencies. Ob/Gyn residents reported significant improvement in their perceived technical competence and stress hardiness after the Boot Camp. However both Ob/Gyn and family medicine residents reported no significant improvement of confidence in their leadership abilities during obstetrical emergencies after the Boot Camp. Boot Camp simulation training early in the curriculum has the potential for enhancing residents' self-assessments of confidence, competency, and stress hardiness in managing obstetrical emergencies.

  9. Stress and training satisfaction among resident doctors in Nigeria: Any justification for a change in training policy?

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    Oluseun Peter Ogunnubi

    2018-01-01

    Full Text Available Background: There are pointers in existing literature to the stressful nature of residency program, thereby placing training physicians at increased risk of psychological distress. Objectives: The study identified perceived stress, its sources, training satisfaction, and the associated sociodemographic characteristics among resident doctors. Materials and Methods: A total of 405 self-administered questionnaires were given to all attendees of the National Postgraduate Medical College Revision Course. The questionnaires sought information on sociodemographic variables, sources of stress, and training satisfaction. Only 20 questionnaires were not returned. Data were collated and analyzed. Results: A majority of the respondents were male (69.1%, mostly between 31 and 35 years of age. Most (80% of the respondents were married while 51.4% had over 4 dependents. All the respondents reported a significant level of stress, and different sources of stress were identified. Only 12 (3.1% of the respondents were satisfied with the quality of training being received in their institutions. Conclusion: Our study found residency training to be stressful for doctors and often compounded by identifiable variables as shown in this study. Such stressful experience can, in turn, have negative impacts on their physical along with mental well-being and the patient care. Thus, there is a need for relevant stakeholders to review the structure of residency program with the view of addressing “modifiable risks” of stress among would-be specialists.

  10. Pediatric crisis resource management training improves emergency medicine trainees' perceived ability to manage emergencies and ability to identify teamwork errors.

    Science.gov (United States)

    Bank, Ilana; Snell, Linda; Bhanji, Farhan

    2014-12-01

    Improved pediatric crisis resource management (CRM) training is needed in emergency medicine residencies because of the variable nature of exposure to critically ill pediatric patients during training. We created a short, needs-based pediatric CRM simulation workshop with postactivity follow-up to determine retention of CRM knowledge. Our aims were to provide a realistic learning experience for residents and to help the learners recognize common errors in teamwork and improve their perceived abilities to manage ill pediatric patients. Residents participated in a 4-hour objectives-based workshop derived from a formal needs assessment. To quantify their subjective abilities to manage pediatric cases, the residents completed a postworkshop survey (with a retrospective precomponent to assess perceived change). Ability to identify CRM errors was determined via a written assessment of scripted errors in a prerecorded video observed before and 1 month after completion of the workshop. Fifteen of the 16 eligible emergency medicine residents (postgraduate year 1-5) attended the workshop and completed the surveys. There were significant differences in 15 of 16 retrospective pre to post survey items using the Wilcoxon rank sum test for non-parametric data. These included ability to be an effective team leader in general (P < 0.008), delegating tasks appropriately (P < 0.009), and ability to ensure closed-loop communication (P < 0.008). There was a significant improvement in identification of CRM errors through the use of the video assessment from 3 of the 12 CRM errors to 7 of the 12 CRM errors (P < 0.006). The pediatric CRM simulation-based workshop improved the residents' self-perceptions of their pediatric CRM abilities and improved their performance on a video assessment task.

  11. Validity and applicability of the Mini International Neuropsychiatric Interview administered by family medicine residents in primary health care in Brazil.

    Science.gov (United States)

    de Azevedo Marques, João Mazzoncini; Zuardi, Antonio W

    2008-01-01

    To evaluate the validity and applicability of the Mini International Neuropsychiatric Interview (MINI) used by family medicine residents in primary health care (PHC) in Brazil. Training for administrating the MINI was given as part of a broad psychiatry education program. Interviews were held with 120 PHC patients who were at least 15 years old. MINI was administered by 25 resident physicians, while the Structured Clinical Interview for Diagnosis (SCID) was administered by a psychiatrist blind to patients' results on the MINI, and the diagnoses on both interviews were compared. The resident physicians answered questions on the applicability of the MINI. Concordance levels for any mental disorder, the broader current diagnostic categories and the most common specific diagnoses were analyzed. Kappa coefficients ranged between 0.65 and 0.85; sensitivity, between 0.75 and 0.92; specificity, between 0.90 and 0.99; positive predictive values (PPV), between 0.60 and 0.86; negative predictive values (NPV), between 0.92 and 0.99; and accuracy, between 0.88 and 0.98. The resident physicians considered MINI comprehensibility and clinical relevance satisfactory. These good psychometric results in a real-world setting may be related to a special training program, which is more frequent, intensive and diversified. In these conditions, the MINI is a useful tool for general practitioners.

  12. Otolaryngology-specific emergency room as a model for resident training.

    Science.gov (United States)

    Sethi, Rosh K V; Kozin, Elliott D; Remenschneider, Aaron K; Lee, Daniel J; Gliklich, Richard E; Shrime, Mark G; Gray, Stacey T

    2015-01-01

    There is a paucity of data on junior resident training in common otolaryngology procedures such as ear debridement, nasal and laryngeal endoscopy, epistaxis management, and peritonsillar abscess drainage. These common procedures represent a critical aspect of training and are necessary skills in general otolaryngology practice. We sought to determine how a dedicated otolaryngology emergency room (ER) staffed by junior residents and a supervising attending provides exposure to common otolaryngologic procedures. Retrospective review. Diagnostic and procedural data for all patients examined in the Massachusetts Eye and Ear Infirmary ER between January 2011 and September 2013 were evaluated. A total of 12,234 patients were evaluated. A total of 5,673 patients (46.4%) underwent a procedure. Each second-year resident performed over 450 procedures, with the majority seen Monday through Friday (75%). The most common procedures in our study included diagnostic nasolaryngoscopy (52.0%), ear debridement (34.4%), and epistaxis control (7.0%) An otolaryngology-specific ER provides junior residents with significant diagnostic and procedural volume in a concentrated period of time. This study demonstrates utility of a unique surgical education model and provides insight into new avenues of investigation for otolaryngology training. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  13. The effect of electronic health record software design on resident documentation and compliance with evidence-based medicine.

    Science.gov (United States)

    Rodriguez Torres, Yasaira; Huang, Jordan; Mihlstin, Melanie; Juzych, Mark S; Kromrei, Heidi; Hwang, Frank S

    2017-01-01

    This study aimed to determine the role of electronic health record software in resident education by evaluating documentation of 30 elements extracted from the American Academy of Ophthalmology Dry Eye Syndrome Preferred Practice Pattern. The Kresge Eye Institute transitioned to using electronic health record software in June 2013. We evaluated the charts of 331 patients examined in the resident ophthalmology clinic between September 1, 2011, and March 31, 2014, for an initial evaluation for dry eye syndrome. We compared documentation rates for the 30 evidence-based elements between electronic health record chart note templates among the ophthalmology residents. Overall, significant changes in documentation occurred when transitioning to a new version of the electronic health record software with average compliance ranging from 67.4% to 73.6% (p Electronic Health Record A had high compliance (>90%) in 13 elements while Electronic Health Record B had high compliance (>90%) in 11 elements. The presence of dialog boxes was responsible for significant changes in documentation of adnexa, puncta, proptosis, skin examination, contact lens wear, and smoking exposure. Significant differences in documentation were correlated with electronic health record template design rather than individual resident or residents' year in training. Our results show that electronic health record template design influences documentation across all resident years. Decreased documentation likely results from "mouse click fatigue" as residents had to access multiple dialog boxes to complete documentation. These findings highlight the importance of EHR template design to improve resident documentation and integration of evidence-based medicine into their clinical notes.

  14. The effect of electronic health record software design on resident documentation and compliance with evidence-based medicine.

    Directory of Open Access Journals (Sweden)

    Yasaira Rodriguez Torres

    Full Text Available This study aimed to determine the role of electronic health record software in resident education by evaluating documentation of 30 elements extracted from the American Academy of Ophthalmology Dry Eye Syndrome Preferred Practice Pattern. The Kresge Eye Institute transitioned to using electronic health record software in June 2013. We evaluated the charts of 331 patients examined in the resident ophthalmology clinic between September 1, 2011, and March 31, 2014, for an initial evaluation for dry eye syndrome. We compared documentation rates for the 30 evidence-based elements between electronic health record chart note templates among the ophthalmology residents. Overall, significant changes in documentation occurred when transitioning to a new version of the electronic health record software with average compliance ranging from 67.4% to 73.6% (p 90% in 13 elements while Electronic Health Record B had high compliance (>90% in 11 elements. The presence of dialog boxes was responsible for significant changes in documentation of adnexa, puncta, proptosis, skin examination, contact lens wear, and smoking exposure. Significant differences in documentation were correlated with electronic health record template design rather than individual resident or residents' year in training. Our results show that electronic health record template design influences documentation across all resident years. Decreased documentation likely results from "mouse click fatigue" as residents had to access multiple dialog boxes to complete documentation. These findings highlight the importance of EHR template design to improve resident documentation and integration of evidence-based medicine into their clinical notes.

  15. Family Medicine needs assessment: Studying the clinical work of ...

    African Journals Online (AJOL)

    admin

    Abstract. Background and Objective: Some universities in sub-Saharan Africa have initiated Family Medicine (FM) residency programs. ... were for information technology (78%) and HIV (46%) training. Conclusion: ..... Emergency medicine. 32.

  16. A Simulation-Based Program to Train Medical Residents to Lead and Perform Advanced Cardiovascular Life Support

    Science.gov (United States)

    Stefan, Mihaela S.; Belforti, Raquel K.; Langlois, Gerard; Rothberg, Michael B.

    2014-01-01

    Background Medical residents are often responsible for leading and performing cardiopulmonary resuscitation; however, their levels of expertise and comfort as leaders of advanced cardiovascular life support (ACLS) teams vary widely. While the current American Heart Association ACLS course provides education in recommended resuscitative protocols, training in leadership skills is insufficient. In this article, we describe the design and implementation in our institution of a formative curriculum aimed at improving residents’ readiness for being leaders of ACLS teams using human patient simulation. Human patient simulation refers to a variety of technologies using mannequins with realistic features, which allows learners to practice through scenarios without putting patients at risk. We discuss the limitations of the program and the challenges encountered in implementation. We also provide a description of the initiation and organization of the program. Case scenarios and assessment tools are provided. Description of the Institutional Training Program Our simulation-based training curriculum consists of 8 simulated patient scenarios during four 1-hour sessions. Postgraduate year–2 and 3 internal medicine residents participate in this program in teams of 4. Assessment tools are utilized only for formative evaluation. Debriefing is used as a teaching strategy for the individual resident leader of the ACLS team to facilitate learning and improve performance. To evaluate the impact of the curriculum, we administered a survey before and after the intervention. The survey consisted of 10 questions answered on a 5-point Likert scale, which addressed residents’ confidence in leading ACLS teams, management of the equipment, and management of cardiac rhythms. Respondents’ mean presimulation (ie, baseline) and postsimulation (outcome) scores were compared using a 2-sample t test. Residents’ overall confidence score improved from 2.8 to 3.9 (P simulation-based training

  17. Cross-cultural psychiatric residency training: the Oregon experience.

    Science.gov (United States)

    Boehnlein, James K; Leung, Paul K; Kinzie, John David

    2008-01-01

    The purpose of this article is to describe the goals and structure of cross-cultural psychiatric training at Oregon Health and Science University (OHSU). This training in core knowledge, skills, and attitudes of cultural psychiatry over the past three decades has included medical students, residents, and fellows, along with allied mental health personnel. The curriculum includes both didactic sessions devoted to core topics in the field and varied clinical experiences in community settings and the Intercultural Psychiatric Program under the supervision of experienced academic faculty. The authors review the central elements of the training experiences and include a detailed description of the core clinical settings and experiences. At the conclusion of their clinical experiences, trainees have specialized cross-cultural psychiatric knowledge and skills, including treatment of refugees and immigrants, sociocultural variables that influence the assessment and treatment of a wide range of psychiatric conditions, and comfort with cultural dynamics that influence both the doctor/patient relationship and collaboration with a wide range of mental health professionals. Because of rapid demographic changes in the U.S. population, providing cross-cultural training for students, residents, and fellows is an essential foundation for the education of the next generation of clinicians and health care leaders. OHSU has provided a long-term model for this training in a busy clinical and academic setting that places an emphasis on multidisciplinary and multicultural collaboration.

  18. Evaluation of Social Media Use by Emergency Medicine Residents and Faculty

    Directory of Open Access Journals (Sweden)

    David Pearson

    2015-10-01

    Full Text Available Introduction: Clinicians and residency programs are increasing their use of social media (SM websites for educational and promotional uses, yet little is known about the use of these sites by residents and faculty. The objective of the study is to assess patterns of SM use for personal and professional purposes among emergency medicine (EM residents and faculty. Methods: In this multi-site study, an 18-question survey was sent by e-mail to the residents and faculty in 14 EM programs and to the Council of Emergency Medicine Residency Directors (CORD listserv via the online tool SurveyMonkey™. We compiled descriptive statistics, including assessment with the chi-square test or Fisher’s exact test. StatsDirect software (v 2.8.0, StatsDirect, Cheshire, UK was used for all analyses. Results: We received 1,314 responses: 63% of respondents were male, 40% were <30 years of age, 39% were between the ages 31 and 40, and 21% were older than 40. The study group consisted of 772 residents and 542 faculty members (15% were program directors, 21% were assistant or associate PDs, 45% were core faculty, and 19% held other faculty positions. Forty-four percent of respondents completed residency more than 10 years ago. Residents used SM markedly more than faculty for social interactions with family and friends (83% vs 65% [p<0.0001], entertainment (61% vs 47% [p<0.0001], and videos (42% vs 23% [p=0.0006]. Residents used Facebook™ and YouTube™ more often than faculty (86% vs 67% [p<0.001]; 53% vs 46% [p=0.01], whereas residents used Twitter™ (19% vs 26% [p=0.005] and LinkedIn™ (15% vs 32% [p<0.0001] less than faculty. Overall, residents used SM sites more than faculty, notably in daily use (30% vs 24% [p<0.001]. For professional use, residents were most interested in its use for open positions/hiring (30% vs 18% [p<0.0001] and videos (33% vs 26% [p=0.005] and less interested than faculty with award postings (22% vs 33% [p<0.0001] or publications (30

  19. Rounds Today: A Qualitative Study of Internal Medicine and Pediatrics Resident Perceptions.

    Science.gov (United States)

    Rabinowitz, Raphael; Farnan, Jeanne; Hulland, Oliver; Kearns, Lisa; Long, Michele; Monash, Bradley; Bhansali, Priti; Fromme, H Barrett

    2016-10-01

    Attending rounds is a key component of patient care and education at teaching hospitals, yet there is an absence of studies addressing trainees' perceptions of rounds. To determine perceptions of pediatrics and internal medicine residents about the current and ideal purposes of inpatient rounds on hospitalist services. In this multi-institutional qualitative study, the authors conducted focus groups with a purposive sample of internal medicine and pediatrics residents at 4 teaching hospitals. The constant comparative method was used to identify themes and codes. The study identified 4 themes: patient care, clinical education, patient/family involvement, and evaluation. Patient care included references to activities on rounds that forwarded care of the patient. Clinical education pertained to teaching/learning on rounds. Patient/family involvement encompassed comments about incorporating patients and families on rounds. Evaluation described residents demonstrating skill for attendings. Resident perceptions of the purposes of rounds aligned with rounding activities described by prior observational studies of rounds. The influence of time pressures and the divergent needs of participants on today's rounds placed these identified purposes in tension, and led to resident dissatisfaction in the achievement of all of them. Suboptimal congruency exists between perceived resident clinical education and specialty-specific milestones. These findings suggest a need for education of multiple stakeholders by (1) enhancing faculty teaching strategies to maximize clinical education while minimizing inefficiencies; (2) informing residents about the value of patient interactions and family-centered rounds; and (3) educating program directors in proper alignment of inpatient rotational objectives to the milestones.

  20. Training in Tobacco Treatments in Psychiatry: A National Survey of Psychiatry Residency Training Directors

    Science.gov (United States)

    Prochaska, Judith J.; Fromont, Sebastien C.; Louie, Alan K.; Jacobs, Marc H.; Hall, Sharon M.

    2016-01-01

    Objective Nicotine dependence is the most prevalent substance abuse disorder among adult psychiatric patients and is a leading cause of death and disability. This study examines training in tobacco treatment in psychiatry residency programs across the United States. Method The authors recruited training directors to complete a survey of their program’s curriculum related to tobacco treatment, attitudes related to treating tobacco in psychiatry, and perceptions of residents’ skills for addressing nicotine dependence in psychiatric patients. Results Respondents were representative of the national pool. Half of the programs provided training in tobacco treatments for a median duration of 1 hour. Content areas covered varied greatly. Programs with tobacco-related training expressed more favorable attitudes toward addressing tobacco in psychiatry and were more likely to report confidence in their residents’ skills for treating nicotine dependence. Programs without tobacco training reported a lack of faculty expertise on tobacco treatments. Most training directors reported moderate to high interest in evaluating a model tobacco curriculum for psychiatry and stated they would dedicate an average of 4 hours of curriculum time. Conclusions The findings demonstrate the need for and interest in a model tobacco treatment curriculum for psychiatry residency training. Training psychiatrists offers the potential of delivering treatment to one of the largest remaining groups of smokers: patients with mental disorders. PMID:17021144