[Medical ethics in residency training].

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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.

Real time curriculum map for internal medicine residency

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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.

Tracking Residents Through Multiple Residency Programs: A Different Approach for Measuring Residents' Rates of Continuing Graduate Medical Education in ACGME-Accredited Programs.

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Byrne, Lauren M; Holt, Kathleen D; Richter, Thomas; Miller, Rebecca S; Nasca, Thomas J

2010-12-01

Increased focus on the number and type of physicians delivering health care in the United States necessitates a better understanding of changes in graduate medical education (GME). Data collected by the Accreditation Council for Graduate Medical Education (ACGME) allow longitudinal tracking of residents, revealing the number and type of residents who continue GME following completion of an initial residency. We examined trends in the percent of graduates pursuing additional clinical education following graduation from ACGME-accredited pipeline specialty programs (specialties leading to initial board certification). Using data collected annually by the ACGME, we tracked residents graduating from ACGME-accredited pipeline specialty programs between academic year (AY) 2002-2003 and AY 2006-2007 and those pursuing additional ACGME-accredited training within 2 years. We examined changes in the number of graduates and the percent of graduates continuing GME by specialty, by type of medical school, and overall. The number of pipeline specialty graduates increased by 1171 (5.3%) between AY 2002-2003 and AY 2006-2007. During the same period, the number of graduates pursuing additional GME increased by 1059 (16.7%). The overall rate of continuing GME increased each year, from 28.5% (6331/22229) in AY 2002-2003 to 31.6% (7390/23400) in AY 2006-2007. Rates differed by specialty and for US medical school graduates (26.4% [3896/14752] in AY 2002-2003 to 31.6% [4718/14941] in AY 2006-2007) versus international medical graduates (35.2% [2118/6023] to 33.8% [2246/6647]). The number of graduates and the rate of continuing GME increased from AY 2002-2003 to AY 2006-2007. Our findings show a recent increase in the rate of continued training for US medical school graduates compared to international medical graduates. Our results differ from previously reported rates of subspecialization in the literature. Tracking individual residents through residency and fellowship programs provides

International issues: Obtaining an adult neurology residency position in the United States: an overview.

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Jordan, Justin T; Sellner, Johann; Struhal, Walter; Schneider, Logan; Mayans, David

2014-04-08

Around the world, there are marked differences in neurology training, including training duration and degree of specialization. In the United States, adult neurology residency is composed of 1 year of internal medicine training (preliminary year) and 3 years of neurology-specific training. Child neurology, which is not the focus of this article, is 2 years of pediatrics and 3 years of neurology training. The route to adult neurology residency training in the United States is standardized and is similar to most other US specialties. Whereas US medical graduates often receive stepwise guidance from their medical school regarding application for residency training, international graduates often enter this complex process with little or no such assistance. Despite this discrepancy, about 10%-15% of residency positions in the United States are filled by international medical graduates.(1,2) In adult neurology specifically, 35% of matched positions were filled by international graduates in 2013, 75% of whom were not US citizens.(1) In an effort to provide a preliminary understanding of the application process and related terminology (table 1) and thereby encourage international residency applicants, we describe the steps necessary to apply for neurology residency in the United States.

The State of Evaluation in Internal Medicine Residency

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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

Predictors of Final Specialty Choice by Internal Medicine Residents

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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

Documentation of quality improvement exposure by internal medicine residency applicants.

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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.

Final Test Analysis of Post Graduate Medical Residents

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Maliheh Arab

2009-04-01

Full Text Available Background and purpose: Multiple choice questions are the most frequent test for medical students. It is important to analysis the overall response to individual  questions in the test.The aim of this study is to analyse questions of post graduate medical residency  tests.Methods: Final annual local (Ramadan medical school and national tests given to three Residency groups  including  17 Obstetrics  and gynecology testees,  7 pediatrics  and  12 internal  medicine  in 2004 were studied. In local tests residents answered to 148, 150 and 144 and in national  tests to ISO MCQS. Questions were  evaluated regarding cognitive domain level, Difficultly index and Discriminative index  and finally to evaluate  the optimal,  proper, acceptable and  ''must  omitted" questions.Results: Questions of local Obstetrics and gynecology, pediatrics and internal medicine tests evaluated the "recall" level in 72%, 72% and 51% and in national  tests 71%,  35% and 19%,  respectively. Questions  with  Discriminative indices  of 0.7 or more (proper  were 3 and  5% in  Obstetrics  and gynecology, 3.5% and 1% in pediatrics and 1% in local and national tests. Proper difficulty indices (30-70  were shown in 53% and 54% in Obstetrics  and gynecology, 34% and 43% in pediatrics and 40% and  42% in internal  medicine.  Generally  evaluating,  "must  omitted" questions in local and national tests were 76% in Obstetrics and gynecology, 81% and 79% in pediatrics and 91% and 85% in internal medicine. The most common causes making the questions to be considered  "must omitted" in studied tests were negative, zero or less than 0.2 Discriminative indices.Conclusion: Test analysis  of final  annual  local  (Ramadan medical  school  and national  tests  of Obstetrics  and gynecology, Pediatrics and internal medicine residency  programs  in 2004 revealed that most of the questions  are planned  in  "recall" level, harbor  improper

Medication Refusal: Resident Rights, Administration Dilemma.

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Haskins, Danielle R; Wick, Jeannette Y

2017-12-01

Occasionally, residents actively or passively refuse to take medications. Residents may refuse medication for a number of reasons, including religious beliefs, dietary restrictions, misunderstandings, cognitive impairment, desire to self-harm, or simple inconvenience. This action creates a unique situation for pharmacists and long-term facility staff, especially if patients have dementia. Residents have the legal right to refuse medications, and long-term care facilities need to employ a process to resolve disagreement between the health care team that recommends the medication and the resident who refuses it. In some cases, simple interventions like selecting a different medication or scheduling medications in a different time can address and resolve the resident's objection. If the medical team and the resident cannot resolve their disagreement, often an ethics consultation is helpful. Documenting the resident's refusal to take any or all medications, the health care team's actions and any other outcomes are important. Residents' beliefs may change over time, and the health care team needs to be prepared to revisit the issue as necessary.

Spaced education in medical residents: An electronic intervention to improve competency and retention of medical knowledge.

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Jason Matos

Full Text Available Spaced education is a novel method that improves medical education through online repetition of core principles often paired with multiple-choice questions. This model is a proven teaching tool for medical students, but its effect on resident learning is less established. We hypothesized that repetition of key clinical concepts in a "Clinical Pearls" format would improve knowledge retention in medical residents.This study investigated spaced education with particular emphasis on using a novel, email-based reinforcement program, and a randomized, self-matched design, in which residents were quizzed on medical knowledge that was either reinforced or not with electronically-administered spaced education. Both reinforced and non-reinforced knowledge was later tested with four quizzes.Overall, respondents incorrectly answered 395 of 1008 questions (0.39; 95% CI, 0.36-0.42. Incorrect response rates varied by quiz (range 0.34-0.49; p = 0.02, but not significantly by post-graduate year (PGY1 0.44, PGY2 0.33, PGY3 0.38; p = 0.08. Although there was no evidence of benefit among residents (RR = 1.01; 95% CI, 0.83-1.22; p = 0.95, we observed a significantly lower risk of incorrect responses to reinforced material among interns (RR = 0.83, 95% CI, 0.70-0.99, p = 0.04.Overall, repetition of Clinical Pearls did not statistically improve test scores amongst junior and senior residents. However, among interns, repetition of the Clinical Pearls was associated with significantly higher test scores, perhaps reflecting their greater attendance at didactic sessions and engagement with Clinical Pearls. Although the study was limited by a low response rate, we employed test and control questions within the same quiz, limiting the potential for selection bias. Further work is needed to determine the optimal spacing and content load of Clinical Pearls to maximize retention amongst medical residents. This particular protocol of spaced education, however, was unique and

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.

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

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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.

Medical students' perceptions of international accreditation.

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Ibrahim, Halah; Abdel-Razig, Sawsan; Nair, Satish C

2015-10-11

This study aimed to explore the perceptions of medical students in a developing medical education system towards international accreditation. Applicants to an Internal Medicine residency program in an academic medical center in the United Arab Emirates (UAE) accredited by the Accreditation Council for Graduate Medical Education-International (ACGME-I) were surveyed between May and June 2014. The authors analysed responses using inductive qualitative thematic analysis to identify emergent themes. Seventy-eight of 96 applicants (81%) completed the survey. The vast majority of respondents 74 (95%) reported that ACGME-I accreditation was an important factor in selecting a residency program. Five major themes were identified, namely improving the quality of education, increasing opportunities, meeting high international standards, improving program structure, and improving patient care. Seven (10%) of respondents felt they would be in a position to pursue fellowship training or future employment in the United States upon graduation from an ACGME-I program. UAE trainees have an overwhelmingly positive perception of international accreditation, with an emphasis on improving the quality of training provided. Misperceptions, however, exist about potential opportunities available to graduates of ACGME-I programs. As more countries adopt the standards of the ACGME-I or other international accrediting bodies, it is important to recognize and foster trainee "buy-in" of educational reform initiatives.

Emergency Medicine Resident Perceptions of Medical Professionalism.

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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

Emergency Medicine Resident Perceptions of Medical Professionalism

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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

Burnout among Dutch medical residents

NARCIS (Netherlands)

Prins, J.T.; Hoekstra-Weebers, J.E.; Van De Wiel, H.B.; Gazendam-Donofrio, S.M.; Sprangers, F.; Jaspers, F.C.; van der Heijden, F.M.

2007-01-01

We examined levels of burnout and relationships between burnout, gender, age, years in training, and medical specialty in 158 medical residents working at the University Medical Center Groningen, the Netherlands. Thirteen percent of the residents met the criteria for burnout, with the highest

Internal Medicine Residents Reject ?Longer and Gentler? Training

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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...

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

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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.

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

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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

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

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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

Medical students’ perceptions of international accreditation

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Abdel-Razig, Sawsan; Nair, Satish C

2015-01-01

Objectives This study aimed to explore the perceptions of medical students in a developing medical education system towards international accreditation. Methods Applicants to an Internal Medicine residency program in an academic medical center in the United Arab Emirates (UAE) accredited by the Accreditation Council for Graduate Medical Education-International (ACGME-I) were surveyed between May and June 2014. The authors analysed responses using inductive qualitative thematic analysis to identify emergent themes. Results Seventy-eight of 96 applicants (81%) completed the survey. The vast majority of respondents 74 (95%) reported that ACGME-I accreditation was an important factor in selecting a residency program. Five major themes were identified, namely improving the quality of education, increasing opportunities, meeting high international standards, improving program structure, and improving patient care. Seven (10%) of respondents felt they would be in a position to pursue fellowship training or future employment in the United States upon graduation from an ACGME-I program. Conclusions UAE trainees have an overwhelmingly positive perception of international accreditation, with an emphasis on improving the quality of training provided. Misperceptions, however, exist about potential opportunities available to graduates of ACGME-I programs. As more countries adopt the standards of the ACGME-I or other international accrediting bodies, it is important to recognize and foster trainee “buy-in” of educational reform initiatives. PMID:26454402

The use of social media to supplement resident medical education - the SMART-ME initiative.

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Galiatsatos, Panagis; Porto-Carreiro, Fernanda; Hayashi, Jennifer; Zakaria, Sammy; Christmas, Colleen

2016-01-01

Residents work at variable times and are often unable to attend all scheduled educational sessions. Therefore, new asynchronistic approaches to learning are essential in ensuring exposure to a comprehensive education. Social media tools may be especially useful, because they are accessed at times convenient for the learner. Assess if the use of Twitter for medical education impacts the attitude and behavior of residents toward using social media for medical education. Preintervention and postintervention surveys. Internal medicine resident physicians were surveyed before the launch of a residency-specific Twitter webpage on August 1, 2013, and again 135 days later, to determine their use of the Twitter application and web page, as well as other social media for medical education. Residents at an internal medicine urban academic training program. All residents within our training program were administered web-based surveys. The surveys assessed resident views and their frequency of use of social media for medical education purposes, and consisted of 10 Likert scale questions. Each answer consisted of a datapoint on a 1-5 scale (1=not useful, 3=useful, 5=very useful). The final survey question was open-ended and asked for general comments. Thirty-five of 50 residents (70%) completed the presurvey and 40 (80%) participated in the postsurvey. At baseline, 34 out of 35 residents used social media and nine specifically used Twitter. Twenty-seven (77%) used social media for medical education; however, only three used Twitter for educational purposes. After the establishment of the Twitter page, the percentage of residents using social media for educational purposes increased (34 of 40 residents, 85%), and 22 used Twitter for this purpose (pmedia could be useful as a medical education tool, which slightly increased from 30 out of 35 in the preintervention survey (p=0.01). Residents believe social media could be used for medical education. After we launched a Twitter page

Overwork Among Residents in India: A Medical Resident′s Perspective

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Gulrez S Azhar

2012-01-01

Full Text Available This paper argues that medical residents who do most of the hard work in big hospitals and medical colleges are overworked. A hierarchical organizational structure, staffing patterns, and fear of failure in examinations leads to overwork among residents going unreported. This can lead to poor academic performance and research work. Gaps in communication have serious implications on patient health. Undesirable practices like LAMA (leave against medical advice also result from overwork. Issues of pay and contracts including mandatory service need to be looked into carefully. National and international recommendations on work hours have consistently been ignored. The solutions suggested are simple and easy to implement.

The Canada-Guyana medical education partnership: using videoconferencing to supplement post-graduate medical education among internal medicine trainees

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William Stokes

2017-04-01

Conclusion: The formation of a resident-led, videoconference teaching series is a mutually beneficial partnership for Canadian and Guyanese medical residents and fosters international collaboration in medical education.

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

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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.

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

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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.

Suicidal Thoughts Among Medical Residents with Burnout

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van der Heijden, Frank; Dillingh, Gea; Bakker, Arnold; Prins, Jelle

2008-01-01

Objectives: Recent research showed that medical residents have a high risk for developing burnout. The present study investigates the prevalence of burnout and its relationship with suicidal thoughts among medical residents. Methods: All Dutch medical residents (n = 5126) received a self-report

[Burnout and quality of life in medical residents].

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Prieto-Miranda, Sergio Emilio; Rodríguez-Gallardo, Gisela Bethsabé; Jiménez-Bernardino, Carlos Alberto; Guerrero-Quintero, Laura Guadalupe

2013-01-01

burnout and quality of life are poorly studied phenomena in postgraduate students, and its effects are unknown. The aim was to investigate the relationship between quality of life and burnout in medical residents. a longitudinal study was performed. We included medical residents who began their postgraduate studies in 2010. The Spanish version of the Quality of Life Profile for the Chronically Ill (PLC, according to its initials in German), and the Maslach Burnout Inventory specific to physicians were applied at the beginning, and six and 12 months later. Descriptive statistics were used for nominal variables. Chi-square and ANOVA were applied to numerical variables. we included 45 residents, the average age was 26.9 ± 2.93 years, 18 (40 %) were female and 27 (60 %) were male. The PLC survey found significant decrease in four of the six scales assessed in the three measurements. The Maslach Burnout Inventory found high levels of emotional exhaustion in the three tests, low levels of depersonalization and low personal gains at the beginning, rising at six and 12 months. The most affected specialty was Internal Medicine. burnout and impaired quality of life for residents exist in postgraduate physicians and it is maintained during the first year of residency.

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

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

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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.

Internal Medicine Residency Program Directors' Views of the Core Entrustable Professional Activities for Entering Residency: An Opportunity to Enhance Communication of Competency Along the Continuum.

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Angus, Steven V; Vu, T Robert; Willett, Lisa L; Call, Stephanie; Halvorsen, Andrew J; Chaudhry, Saima

2017-06-01

To examine internal medicine (IM) residency program directors' (PDs') perspectives on the Core Entrustable Professional Activities for Entering Residency (Core EPAs)-introduced into undergraduate medical education to further competency-based assessment-and on communicating competency-based information during transitions. A spring 2015 Association of Program Directors in Internal Medicine survey asked PDs of U.S. IM residency programs for their perspectives on which Core EPAs new interns must or should possess on day 1, which are most essential, and which have the largest gap between expected and observed performance. Their views and preferences were also requested regarding communicating competency-based information at transitions from medical school to residency and residency to fellowship/employment. The response rate was 57% (204/361 programs). The majority of PDs felt new interns must/should possess 12 of the 13 Core EPAs. PDs' rankings of Core EPAs by relative importance were more varied than their rankings by the largest gaps in performance. Although preferred timing varied, most PDs (82%) considered it important for medical schools to communicate Core EPA-based information to PDs; nearly three-quarters (71%) would prefer a checklist format. Many (60%) would be willing to provide competency-based evaluations to fellowship directors/employers. Most (> 80%) agreed that there should be a bidirectional communication mechanism for programs/employers to provide feedback on competency assessments. The gaps identified in Core EPA performance may help guide medical schools' curricular and assessment tool design. Sharing competency-based information at transitions along the medical education continuum could help ensure production of competent, practice-ready physicians.

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

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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.

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

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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.

The use of social media to supplement resident medical education – the SMART-ME initiative

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Galiatsatos, Panagis; Porto-Carreiro, Fernanda; Hayashi, Jennifer; Zakaria, Sammy; Christmas, Colleen

2016-01-01

Background Residents work at variable times and are often unable to attend all scheduled educational sessions. Therefore, new asynchronistic approaches to learning are essential in ensuring exposure to a comprehensive education. Social media tools may be especially useful, because they are accessed at times convenient for the learner. Objective Assess if the use of Twitter for medical education impacts the attitude and behavior of residents toward using social media for medical education. Design Preintervention and postintervention surveys. Internal medicine resident physicians were surveyed before the launch of a residency-specific Twitter webpage on August 1, 2013, and again 135 days later, to determine their use of the Twitter application and web page, as well as other social media for medical education. Participants Residents at an internal medicine urban academic training program. Main Measures All residents within our training program were administered web-based surveys. The surveys assessed resident views and their frequency of use of social media for medical education purposes, and consisted of 10 Likert scale questions. Each answer consisted of a datapoint on a 1–5 scale (1=not useful, 3=useful, 5=very useful). The final survey question was open-ended and asked for general comments. Key Results Thirty-five of 50 residents (70%) completed the presurvey and 40 (80%) participated in the postsurvey. At baseline, 34 out of 35 residents used social media and nine specifically used Twitter. Twenty-seven (77%) used social media for medical education; however, only three used Twitter for educational purposes. After the establishment of the Twitter page, the percentage of residents using social media for educational purposes increased (34 of 40 residents, 85%), and 22 used Twitter for this purpose (pincreased from 11.4 to 60.0% (psocial media could be useful as a medical education tool, which slightly increased from 30 out of 35 in the preintervention survey (p=0

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

Geriatrics education is associated with positive attitudes toward older people in internal medicine residents: a multicenter study.

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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.

Medical Student Interest in Flexible Residency Training Options.

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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.

Resident duty hour modification affects perceptions in medical education, general wellness, and ability to provide patient care.

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Moeller, Andrew; Webber, Jordan; Epstein, Ian

2016-07-13

Resident duty hours have recently been under criticism, with concerns for resident and patient well-being. Historically, call shifts have been long, and some residency training programs have now restricted shift lengths. Data and opinions about the effects of such restrictions are conflicting. The Internal Medicine Residency Program at Dalhousie University recently moved from a traditional call structure to a day float/night float system. This study evaluated how this change in duty hours affected resident perceptions in several key domains. Senior residents from an internal medicine training program in Canada responded to an anonymous online survey immediately before and 6 months after the implementation of duty hour reform. The survey contained questions relating to three major domains: resident wellness, ability to deliver quality health care, and medical education experience. Mean pre- and post-intervention scores were compared using the t-test for paired samples. Twenty-three of 27 (85 %) senior residents completed both pre- and post-reform surveys. Residents perceived significant changes in many domains with duty hour reform. These included improved general wellness, less exposure to personal harm, fewer feelings of isolation, less potential for error, improvement in clinical skills expertise, increased work efficiency, more successful teaching, increased proficiency in medical skills, more successful learning, and fewer rotation disruptions. Senior residents in a Canadian internal medicine training program perceived significant benefits in medical education experience, ability to deliver healthcare, and resident wellness after implementation of duty hour reform.

Admission factors associated with international medical graduate certification success: a collaborative retrospective review of postgraduate medical education programs in Ontario.

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Grierson, Lawrence E M; Mercuri, Mathew; Brailovsky, Carlos; Cole, Gary; Abrahams, Caroline; Archibald, Douglas; Bandiera, Glen; Phillips, Susan P; Stirrett, Glenna; Walton, J Mark; Wong, Eric; Schabort, Inge

2017-11-24

The failure rate on certification examinations of The College of Family Physicians of Canada (CFPC) and the Royal College of Physicians and Surgeons of Canada (RCPSC) is significantly higher for international medical graduates than for Canadian medical school graduates. The purpose of the current study was to generate evidence that supports or refutes the validity of hypotheses proposed to explain the lower success rates. We conducted retrospective analyses of admissions and certification data to determine the factors associated with success of international medical graduate residents on the certification examinations. International medical graduates who entered an Ontario residency program between 2005 and 2012 and had written a certification examination by the time of the analysis (2015) were included in the study. Data available at the time of admission for each resident, including demographic characteristics, previous experiences and previous professional experiences, were collected from each of the 6 Ontario medical schools and matched with certification examination results provided by The CFPC and the RCPSC. We developed logistic regression models to determine the association of each factor with success on the examinations. Data for 900 residents were analyzed. The models revealed resident age to be strongly associated with performance across all examinations. Fluency in English, female sex and the Human Development Index value associated with the country of medical school training had differential associations across the examinations. The findings should contribute to an improved understanding of certification success by international medical graduates, help residency programs identify at-risk residents and underpin the development of specific educational and remedial interventions. In considering the results, it should be kept in mind that some variables are not amenable to changes in selection criteria. Copyright 2017, Joule Inc. or its licensors.

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

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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.

Hospitalist career decisions among internal medicine residents.

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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.

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

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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

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

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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

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

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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

E-Learning and Medical Residents, a Qualitative Perspective

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Segerman, Jill; Crable, Elaine; Brodzinski, James

2016-01-01

Medical education helps ensure doctors acquire skills and knowledge needed to care for patients. However, resident duty hour restrictions have impacted the time residents have available for medical education, leaving resident educators searching for alternate options for effective medical education. Classroom situated e-learning, a blended…

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

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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

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.

Science.gov (United States)

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.

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

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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

What skills should new internal medicine interns have in july? A national survey of internal medicine residency program directors.

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Angus, Steven; Vu, T Robert; Halvorsen, Andrew J; Aiyer, Meenakshy; McKown, Kevin; Chmielewski, Amy F; McDonald, Furman S

2014-03-01

The transition from medical student to intern may cause stress and burnout in new interns and the delivery of suboptimal patient care. Despite a formal set of subinternship curriculum guidelines, program directors have expressed concern regarding the skill set of new interns and the lack of standardization in that skill set among interns from different medical schools. To address these issues, the Accreditation Council for Graduate Medical Education's Next Accreditation System focuses on the development of a competency-based education continuum spanning undergraduate, graduate, and continuing medical education. In 2010, the Clerkship Directors in Internal Medicine subinternship task force, in collaboration with the Association of Program Directors in Internal Medicine survey committee, surveyed internal medicine residency program directors to determine which competencies or skills they expected from new medical school graduates. The authors summarized the results using categories of interest. In both an item rank list and free-text responses, program directors were nearly uniform in ranking the skills they deemed most important for new interns-organization and time management and prioritization skills; effective communication skills; basic clinical skills; and knowing when to ask for assistance. Stakeholders should use the results of this survey as they develop a milestone-based curriculum for the fourth year of medical school and for the internal medicine subinternship. By doing so, they should develop a standardized set of skills that meet program directors' expectations, reduce the stress of transitions across the educational continuum, and improve the quality of patient care.

Monitoring stress among internal medicine residents: an experience-driven, practical and short measure.

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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.

Effect of a Community-Based Service Learning Experience in Geriatrics on Internal Medicine Residents and Community Participants.

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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.

[Highlights of hospital-based internal medicine in 2010: chief residents' perspective].

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Uhlmann, Marc; Burnard, Jérôme; Cosma Rochat, Monica; Gabus, Vincent; Micheloud, Valérie Geiser; Gobin, Niels; Laurent, Jean-Christophe; Marino, Laura; Méan, Marie; Merz, Laurent; Regamey, Julien; Stadelmann, Raphaël

2011-02-02

Applying knowledge acquired from recent medical studies to patient care poses a daily challenge to physicians. Chief residents from the Department of Internal Medicine at the University Hospital of Lausanne carried out a review of some of the issues they considered important. The conclusions of these various publications may have a significant impact on the daily practice of hospital-based internal medicine. Modern medicine based on scientific studies is a reminder that in spite of the essential importance of clinical experience, it is crucial to confront it with the results of relevant publications from the medical literature.

Medical residents' job satisfaction and their related factors.

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Chung, Eun-Kyung; Han, Eui-Ryoung; Woo, Young-Jong

2013-03-01

This study was conducted to investigate medical residents' job satisfaction and their related factors to improve the quality of residency program. The study subjects were 159 medical residents being trained at Chonnam National University Hospital, South Korea, in 2011. The participants were asked to complete a short form Minnesota satisfaction questionnaire (MSQ). The mean score for 20 items on the short form MSQ varied between 2.91 and 3.64 on a 5-point Likert scale. The assessment of related factors with job satisfaction revealed that medical residents had higher levels for job satisfaction, particularly those who were women (beta=0.200, p=0.022), and those who had mentorship experience (beta=0.219, p=0.008). This study results indicate that we should expand and support the mentorship program during medical residency to promote job satisfaction.

Using television shows to teach communication skills in internal medicine residency.

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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.

The Use of a Social Media Based Curriculum for Newly Matched Interns Transitioning into Emergency Medicine Residency

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Joel C Park, MD

2018-04-01

Full Text Available Audience: This is an online social media curriculum aimed at the incoming Emergency Department (ED intern. This curriculum is designed to foster collaborative learning in preparation for the upcoming intern year. Introduction: Graduating medical students tend to have few clinical experiences at the end of their fourth year. For many students, their last ED rotation is six months or more before the start of their internship. In addition, the transition from being a medical student to an intern can be quite abrupt and jarring, with little time to adjust to the rigorous new clinical demands of internship. To ease this transition, the Slack channels provide an easy medium to share thoughts and ideas regarding clinical cases provided by the Emergency Medicine (EM faculty. After performing a PubMed, Google Scholar, and Medline search, we found that no interventions have been described utilizing social media for helping rising interns to transition from medical school to emergency medicine residency. Medical school curriculum varies widely, and medical students often struggle with this transition.1,2 Multiple authors have evaluated the use of pre-graduation or early internship boot camps as preparation for emergency medicine residencies, but to our knowledge, there is no existing curriculum that is designed specifically for the transition between medical school and internship.3,4,5 We designed a social media based curriculum that addressed several of the competencies targeted by these boot camp programs4 and based on Accreditation Council for Graduate Medical Education (ACGME level 1 milestones in patient care. This curriculum provides an interactive, case-based learning platform for incoming residents prior to the start of residency. Using Slack, learners can post responses in real-time that can be seen by the entire group of incoming interns. The incoming interns will be able to interact with other users, either in a public or private forum, and

Complexity in graduate medical education: a collaborative education agenda for internal medicine and geriatric medicine.

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Chang, Anna; Fernandez, Helen; Cayea, Danelle; Chheda, Shobhina; Paniagua, Miguel; Eckstrom, Elizabeth; Day, Hollis

2014-06-01

Internal medicine residents today face significant challenges in caring for an increasingly complex patient population within ever-changing education and health care environments. As a result, medical educators, health care system leaders, payers, and patients are demanding change and accountability in graduate medical education (GME). A 2012 Society of General Internal Medicine (SGIM) retreat identified medical education as an area for collaboration between internal medicine and geriatric medicine. The authors first determined a short-term research agenda for resident education by mapping selected internal medicine reporting milestones to geriatrics competencies, and listing available sample learner assessment tools. Next, the authors proposed a strategy for long-term collaboration in three priority areas in clinical medicine that are challenging for residents today: (1) team-based care, (2) transitions and readmissions, and (3) multi-morbidity. The short-term agenda focuses on learner assessment, while the long-term agenda allows for program evaluation and improvement. This model of collaboration in medical education combines the resources and expertise of internal medicine and geriatric medicine educators with the goal of increasing innovation and improving outcomes in GME targeting the needs of our residents and their patients.

Attitudes toward euthanasia, assisted suicide and termination of life-sustaining treatment of Puerto Rican medical students, medical residents, and faculty.

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Ramirez Rivera, J; Rodríguez, R; Otero Igaravidez, Y

2000-01-01

To elicit the opinion of Puerto Rican medical students, residents and internal medicine faculty as to the appropriateness of euthanasia and physician-assisted suicide and end-of-life management. Survey using a 16-item questionnaire answered within a two-month period in the fall of 1996. Rounds or faculty meetings at teaching hospitals located in the north, south and southwest of the island of Puerto Rico. There were 424 participants. The questionnaires of 279 medical students, 75 medical residents, and 35 internal medicine faculty members were analyzed. Thirty-five questionnaires, which were incomplete or answered by non-Puerto Rican participants, were excluded. Frequency of support of active euthanasia, physician-assisted suicide, withholding or withdrawing life-sustaining treatment with informed consent was determined. Whether it was ethical to prescribe full doses of drugs needed to alleviate pain even if it would hasten death, or agree to limit or restrict resources for the terminally ill was also determined. Forty per cent of the students, 33% of the residents, and 20% of the faculty supported euthanasia. If physician-assisted suicide were legalized, 50 per cent of the students, 43 per cent of the residents and 45 percent of the faculty would not be opposed to it. Sixty-eight per cent of the students, 67 per cent of the residents and 88 per cent of the faculty would support withholding or withdrawing life-sustaining treatment for dying patients with informed consent. Seventy-nine per cent of residents, 80 per cent of the faculty but only 54 per cent of medical students would prescribe full doses of drugs needed to alleviate pain in dying patients even if they would hasten death. Thirty-six per cent of the residents and faculty would agree to limit the use of medical resources for the terminally ill but only sixteen per cent of medical students would do so. The acceptance of euthanasia was inversely proportional to the clinical experience of the respondents: 40

Discrimination against international medical graduates in the United States residency program selection process.

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Desbiens, Norman A; Vidaillet, Humberto J

2010-01-25

Available evidence suggests that international medical graduates have improved the availability of U.S. health care while maintaining academic standards. We wondered whether studies had been conducted to address how international graduates were treated in the post-graduate selection process compared to U.S. graduates. We conducted a Medline search for research on the selection process. Two studies provide strong evidence that psychiatry and family practice programs respond to identical requests for applications at least 80% more often for U.S. medical graduates than for international graduates. In a third study, a survey of surgical program directors, over 70% perceived that there was discrimination against international graduates in the selection process. There is sufficient evidence to support action against discrimination in the selection process. Medical organizations should publish explicit proscriptions of discrimination against international medical graduates (as the American Psychiatric Association has done) and promote them in diversity statements. They should develop uniform and transparent policies for program directors to use to select applicants that minimize the possibility of non-academic discrimination, and the accreditation organization should monitor whether it is occurring. Whether there should be protectionism for U.S. graduates or whether post-graduate medical education should be an unfettered meritocracy needs to be openly discussed by medicine and society.

Medical Resident Workload at a Multidisciplinary Hospital in Iran

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Anahita Sadeghi

2014-12-01

Full Text Available Introduction: Medical resident workload has been shown to be associated with learning efficiency and patient satisfaction. However, there is limited evidence about it in developing countries. This study aimed to evaluate the medical resident workload in a multidisciplinary teaching hospital in Tehran, Iran.Methods: All medical residents at Shariati Hospital, a teaching hospital affiliated with Tehran University of Medical Science, who were working between November and December 2011 were enrolled in this cross-sectional study. A self–reported questionnaire was used to gather information about their duty hours (including daily activities and shifts and financial issues.Results:135 (52.5% out of 257 residents responded to the questionnaire. 72 (53.3% residents were in surgical departments and 63 (46.7% were in non-surgical departments. Mean duty hours per month were significantly higher in surgical (350.8 ±76.7 than non-surgical (300.6±74.2 departments (p=0.001. Three cardiology (a non-surgical group residents (5.7% and 30 residents (41% in surgical groups (p<0.001 declared a number of “on-calls in the hospital” more than the approved number in the curriculum. The majority of residents (97.8% declared that their salary was not sufficient to manage their lives and they needed other financial resources. Conclusion: Medical residents at teaching hospitals in Iran suffer from high workloads and low income. There is a need to reduce medical resident workload and increase salary to improve worklife balance and finances.

Gender differences in salary of internal medicine residency directors: a national survey.

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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.

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

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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.

Using television shows to teach communication skills in internal medicine residency

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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.

[Burnout effect on academic progress of Oncology medical residents].

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González-Ávila, Gabriel; Bello-Villalobos, Herlinda

2014-01-01

In the formative period of the courses taken in medical specializations, new and greater responsibilities are accepted by physicians in personal and academic spheres. The interaction of several factors that encompass the practice of these physicians could surpass their capacity to cope, causing on these professionals a high level of stress and professional exhaustion, which will affect their academic development. The objective of this research was to establish if the occupational stress of these medical residents affects their academic progress. We administered the Spanish version of the Maslach Burnout Inventory (MBI) to 52 residents of three specializations in Oncology (Medical Oncology, Surgical Oncology, and Radio-Oncology). These residents accepted voluntarily at the same time of their third cognitive exam. The prevalence of burnout syndrome was 13.5 %, with a high frequency among medical residents of first degree. Medical Oncology residents showed a higher emotional exhaustion and lower personal fulfillment. Considering the three specializations, the academic progress was higher in the third year, with a significant difference to Surgical Oncology and Medical Oncology (p = 0.026 and 0.015, respectively). No significant difference was found between burnout syndrome, academic progress and sociodemographic characteristics. The presence of burnout syndrome does not affect the academic progress of Oncology medical residents.

Assessment of medical resident's attention to the health literacy level of newly admitted patients

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Cecile Karsenty

2013-12-01

Full Text Available Objectives: The objective of this study was to assess communication at the bedside in the emergency room between residents and their patients in order to identify common communication gaps. We also intended to evaluate whether residents for whom English is a second language (ESL residents communicate less effectively. Methods: A scorable checklist was developed in order to assess and identify communication gaps between the residents and their patients. Medical students observed the internal medicine and family medicine residents while they admitted patients to the medical service in the Emergency Room. Before this, medical students were trained for two weeks with a senior internist. The role of the medical student was not revealed; rather they were self-described as observers of the admission process. Results: Over an 8 week period, 71 observations were made of 27 medicine residents. 71 patient intakes were observed, evaluating 27 residents. In 52.1% of these interactions, the residents used medical acronyms when communicating with the patients. During 66.2% of interactions, technical medical terms or expressions were used during the history taking and in only 27.6% of those cases were the terms explained at least partially. Teach back technique was not observed in any of the interactions evaluated. Data was also analyzed based on whether the doctors were ESL residents or native English speakers. ESL residents tended to use significantly more technical language than the native English speakers, but the native English speakers tended to use more acronyms. Conclusions: How much patients understand of what their doctor says is called “health literacy.” Resident physicians often overestimate their patients’ health literacy, and this leads to communication gaps which have the potential to result in poorer health outcomes for the patients. The checklist developed for this pilot study assessed how well residents tailor their communication to

Spectrum of tablet computer use by medical students and residents at an academic medical center

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Robert Robinson

2015-07-01

Full Text Available Introduction. The value of tablet computer use in medical education is an area of considerable interest, with preliminary investigations showing that the majority of medical trainees feel that tablet computers added value to the curriculum. This study investigated potential differences in tablet computer use between medical students and resident physicians.Materials & Methods. Data collection for this survey was accomplished with an anonymous online questionnaire shared with the medical students and residents at Southern Illinois University School of Medicine (SIU-SOM in July and August of 2012.Results. There were 76 medical student responses (26% response rate and 66 resident/fellow responses to this survey (21% response rate. Residents/fellows were more likely to use tablet computers several times daily than medical students (32% vs. 20%, p = 0.035. The most common reported uses were for accessing medical reference applications (46%, e-Books (45%, and board study (32%. Residents were more likely than students to use a tablet computer to access an electronic medical record (41% vs. 21%, p = 0.010, review radiology images (27% vs. 12%, p = 0.019, and enter patient care orders (26% vs. 3%, p < 0.001.Discussion. This study shows a high prevalence and frequency of tablet computer use among physicians in training at this academic medical center. Most residents and students use tablet computers to access medical references, e-Books, and to study for board exams. Residents were more likely to use tablet computers to complete clinical tasks.Conclusions. Tablet computer use among medical students and resident physicians was common in this survey. All learners used tablet computers for point of care references and board study. Resident physicians were more likely to use tablet computers to access the EMR, enter patient care orders, and review radiology studies. This difference is likely due to the differing educational and professional demands placed on

A model of self-directed learning in internal medicine residency: a qualitative study using grounded theory.

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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.

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

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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.

Spectrum of tablet computer use by medical students and residents at an academic medical center.

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Robinson, Robert

2015-01-01

Introduction. The value of tablet computer use in medical education is an area of considerable interest, with preliminary investigations showing that the majority of medical trainees feel that tablet computers added value to the curriculum. This study investigated potential differences in tablet computer use between medical students and resident physicians. Materials & Methods. Data collection for this survey was accomplished with an anonymous online questionnaire shared with the medical students and residents at Southern Illinois University School of Medicine (SIU-SOM) in July and August of 2012. Results. There were 76 medical student responses (26% response rate) and 66 resident/fellow responses to this survey (21% response rate). Residents/fellows were more likely to use tablet computers several times daily than medical students (32% vs. 20%, p = 0.035). The most common reported uses were for accessing medical reference applications (46%), e-Books (45%), and board study (32%). Residents were more likely than students to use a tablet computer to access an electronic medical record (41% vs. 21%, p = 0.010), review radiology images (27% vs. 12%, p = 0.019), and enter patient care orders (26% vs. 3%, p e-Books, and to study for board exams. Residents were more likely to use tablet computers to complete clinical tasks. Conclusions. Tablet computer use among medical students and resident physicians was common in this survey. All learners used tablet computers for point of care references and board study. Resident physicians were more likely to use tablet computers to access the EMR, enter patient care orders, and review radiology studies. This difference is likely due to the differing educational and professional demands placed on resident physicians. Further study is needed better understand how tablet computers and other mobile devices may assist in medical education and patient care.

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

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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.

The "resident's dilemma"? Values and strategies of medical residents for education interactions: a cellular automata simulation.

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Heckerling, P S; Gerber, B S; Weiner, S J

2006-01-01

Medical residents engage in formal and informal education interactions with fellow residents during the working day, and can choose whether to spend time and effort on such interactions. Time and effort spent on such interactions can bring learning and personal satisfaction to residents, but may also delay completion of clinical work. Using hypothetical cases, we assessed the values and strategies of internal medicine residents at one hospital for both cooperative and non-cooperative education interactions with fellow residents. We then used these data and cellular automata models of two-person games to simulate repeated interactions between residents, and to determine which strategies resulted in greatest accrued value. We conducted sensitivity analyses on several model parameters, to test the robustness of dominant strategies to model assumptions. Twenty-nine of the 57 residents (50.9%) valued cooperation more than non-cooperation no matter what the other resident did during the current interaction. Similarly, thirty-six residents (63.2%) endorsed an unconditional always-cooperate strategy no matter what the other resident had done during their previous interaction. In simulations, an always-cooperate strategy accrued more value (776.42 value units) than an aggregate of strategies containing non-cooperation components (675.0 value units, p = 0.052). Only when the probability of strategy errors reached 50%, or when values were re-ordered to match those of a Prisoner's Dilemma, did non-cooperation-based strategies accrue the most value. Cooperation-based values and strategies were most frequent among our residents, and dominated in simulations of repeated education interactions between them.

Can Medical School Performance Predict Residency Performance? Resident Selection and Predictors of Successful Performance in Obstetrics and Gynecology

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Stohl, Hindi E.; Hueppchen, Nancy A.; Bienstock, Jessica L.

2010-01-01

Background During the evaluation process, Residency Admissions Committees typically gather data on objective and subjective measures of a medical student's performance through the Electronic Residency Application Service, including medical school grades, standardized test scores, research achievements, nonacademic accomplishments, letters of recommendation, the dean's letter, and personal statements. Using these data to identify which medical students are likely to become successful residents in an academic residency program in obstetrics and gynecology is difficult and to date, not well studied. Objective To determine whether objective information in medical students' applications can help predict resident success. Method We performed a retrospective cohort study of all residents who matched into the Johns Hopkins University residency program in obstetrics and gynecology between 1994 and 2004 and entered the program through the National Resident Matching Program as a postgraduate year-1 resident. Residents were independently evaluated by faculty and ranked in 4 groups according to perceived level of success. Applications from residents in the highest and lowest group were abstracted. Groups were compared using the Fisher exact test and the Student t test. Results Seventy-five residents met inclusion criteria and 29 residents were ranked in the highest and lowest quartiles (15 in highest, 14 in lowest). Univariate analysis identified no variables as consistent predictors of resident success. Conclusion In a program designed to train academic obstetrician-gynecologists, objective data from medical students' applications did not correlate with successful resident performance in our obstetrics-gynecology residency program. We need to continue our search for evaluation criteria that can accurately and reliably select the medical students that are best fit for our specialty. PMID:21976076

Description of a medical writing rotation for a postgraduate pharmacy residency program.

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Brown, Jamie N; Tiemann, Kelsey A; Ostroff, Jared L

2014-04-01

To provide a description of a pharmacy residency rotation dedicated to medical writing developed at a tertiary care academic medical center. Contribution to the medical literature is an important component of professional pharmacy practice, and there are many benefits seen by practitioners actively involved in scholarly activities. Residency programs have an opportunity to expand beyond the standard roles of postgraduate pharmacist training but rarely is there formal instruction on medical writing skills or are scholarship opportunities provided to residents. In order to address this deficiency, a residency program may consider the implementation of a formal Medical Writing rotation. This rotation is designed to introduce the resident to medical writing through active discussion on medical writing foundational topics, engage the resident in a collaborative review of a manuscript submitted to a peer-reviewed professional journal, and support the resident in the design and composition of manuscript of publishable quality. A structured Medical Writing rotation during a pharmacy resident's training can help develop the skills necessary to promote scholarly activities and foster resident interest in future pursuit of professional medical writing.

How residents and interns utilise and perceive the personal digital assistant and UpToDate

Directory of Open Access Journals (Sweden)

Lim Tow

2008-07-01

Full Text Available Abstract Background In this era of evidence-based medicine, doctors are increasingly using information technology to acquire medical knowledge. This study evaluates how residents and interns utilise and perceive the personal digital assistant (PDA and the online resource UpToDate. Methods This is a questionnaire survey of all residents and interns in a tertiary teaching hospital. Results Out of 168 doctors, 134 (79.8% responded to the questionnaire. Only 54 doctors (40.3% owned a PDA. Although these owners perceived that the PDA was most useful for providing drug information, followed by medical references, scheduling and medical calculators, the majority of them did not actually have medical software applications downloaded on their PDAs. The greatest concerns highlighted for the PDA were the fear of loss and breakage, and the preference for working with desktop computers and paper. Meanwhile, only 76 doctors (56.7% used UpToDate, even though the hospital had an institutional subscription for it. Although 93.4% of these users would recommend UpToDate to a colleague, only 57.9% stated that the use of UpToDate had led to a change in their management of patients. Conclusion Although UpToDate and various PDA software applications were deemed useful by some of the residents and interns in our study, both digital tools were under-utilised. More should be done to facilitate the use of medical software applications on PDAs, to promote awareness of tools for evidence-based medicine such as UpToDate, and to facilitate the application of evidence-based medicine in daily clinical practice.

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

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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

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

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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.

E-learning in graduate medical education: survey of residency program directors.

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Wittich, Christopher M; Agrawal, Anoop; Cook, David A; Halvorsen, Andrew J; Mandrekar, Jayawant N; Chaudhry, Saima; Dupras, Denise M; Oxentenko, Amy S; Beckman, Thomas J

2017-07-11

E-learning-the use of Internet technologies to enhance knowledge and performance-has become a widely accepted instructional approach. Little is known about the current use of e-learning in postgraduate medical education. To determine utilization of e-learning by United States internal medicine residency programs, program director (PD) perceptions of e-learning, and associations between e-learning use and residency program characteristics. We conducted a national survey in collaboration with the Association of Program Directors in Internal Medicine of all United States internal medicine residency programs. Of the 368 PDs, 214 (58.2%) completed the e-learning survey. Use of synchronous e-learning at least sometimes, somewhat often, or very often was reported by 85 (39.7%); 153 programs (71.5%) use asynchronous e-learning at least sometimes, somewhat often, or very often. Most programs (168; 79%) do not have a budget to integrate e-learning. Mean (SD) scores for the PD perceptions of e-learning ranged from 3.01 (0.94) to 3.86 (0.72) on a 5-point scale. The odds of synchronous e-learning use were higher in programs with a budget for its implementation (odds ratio, 3.0 [95% CI, 1.04-8.7]; P = .04). Residency programs could be better resourced to integrate e-learning technologies. Asynchronous e-learning was used more than synchronous, which may be to accommodate busy resident schedules and duty-hour restrictions. PD perceptions of e-learning are relatively moderate and future research should determine whether PD reluctance to adopt e-learning is based on unawareness of the evidence, perceptions that e-learning is expensive, or judgments about value versus effectiveness.

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

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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.

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

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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

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

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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

Burnout Comparison among Residents in Different Medical Specialties

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Martini, Shahm; Arfken, Cynthia L.; Churchill, Amy; Balon, Richard

2004-01-01

Objective: To investigate resident burnout in relation to work and home-related factors. Method: Maslach Burnout Inventory was mailed to residents in eight different medical specialties, with a response rate of 35%. Results: Overall, 50% of residents met burnout criteria, ranging from 75% (obstetrics/gynecology) to 27% (family medicine). The first…

Curricula and Organization of Primary Care Residencies in Internal Medicine.

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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…

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

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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.

Residency choices by graduating medical students: why not pathology?

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Hung, Tawny; Jarvis-Selinger, Sandra; Ford, Jason C

2011-06-01

Pathology is an unpopular residency choice for medical students worldwide. In some countries, this has contributed to a crisis in pathologist human resources that has affected the quality of clinical laboratories. Several previous studies have used information from junior medical students and from residents to suggest ways of improving pathology recruitment. There are, however, no published studies of pathology residency choice that focus on the senior medical students who must be recruited. This study uses focus groups of senior medical students to explore both general and pathology-specific influences on residency choice. Several general influences are identified, including students' expectations for their future clinical practices, their own clinical rotation experiences, influences from other people including mentors, and their choice to reject certain fields. Several specific antipathology influences are also revealed, including negative stereotypes about pathologists, a perceived incompatibility of personality between most medical students (extroverted) and pathologists (introverted), and perceptions of pathologists as being in some ways nonmedical. The most important antipathology influence was that, from the students' perspective, pathology was utterly invisible in clinical practice. Most students did not consider and then reject a pathology residency: instead, pathology was completely ignored. Given the importance of clerkship electives in influencing medical student career choice, promoting clerkship experiences in pathology may improve recruitment. However, departments of pathology must first make pathology visible to students and teach them how pathologists contribute to clinical care. Copyright © 2011 Elsevier Inc. All rights reserved.

Academic Medical Library Services Contribute to Scholarship in Medical Faculty and Residents

Directory of Open Access Journals (Sweden)

Peace Ossom Williamson

2017-09-01

Full Text Available A Review of: Quesenberry, A. C., Oelschlegel, S., Earl, M., Leonard, K., & Vaughn, C. J. (2016. The impact of library resources and services on the scholarly activity of medical faculty and residents. Medical Reference Services Quarterly, 35(3, 259-265. http://dx.doi.org/10.1080/02763869.2016.1189778 Abstract Objective – To assess the impact of academic medical library services and resources on information-seeking behaviours during the academic efforts of medical faculty and residents. Design – Value study derived from a 23-item survey. Setting – Public medical residency program and training hospital in Tennessee, USA. Subjects – 433 faculty and residents currently employed by or completing residency in an academic medical centre. Methods – Respondents completed a 23-question survey about their use of library resources and services in preparation for publishing, presenting, and teaching. The library services in the survey included literature searches completed by librarians and document delivery for preparation of publications, presentations, and lecture material. The survey also included questions about how resources were being accessed in preparation for scholarship. The survey sought information on whether respondents published articles or chapters or presented papers or posters in the previous three years. If respondents answered in the affirmative to one of the aforementioned methods of scholarship, they were provided with further questions about how they access library resources and whether they sought mediated literature search and document delivery services in preparation for their recent presentations and publications. The survey also included questions concerning what types of scholarly activity prompt faculty and residents to use online library resources. Main Results – The study was provided to 433 subjects, including 220 faculty and 213 residents, contacted through an email distribution list. The response rate to the

Midwives in medical student and resident education and the development of the medical education caucus toolkit.

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Radoff, Kari; Nacht, Amy; Natch, Amy; McConaughey, Edie; Salstrom, Jan; Schelling, Karen; Seger, Suzanne

2015-01-01

Midwives have been involved formally and informally in the training of medical students and residents for many years. Recent reductions in resident work hours, emphasis on collaborative practice, and a focus on midwives as key members of the maternity care model have increased the involvement of midwives in medical education. Midwives work in academic settings as educators to teach the midwifery model of care, collaboration, teamwork, and professionalism to medical students and residents. In 2009, members of the American College of Nurse-Midwives formed the Medical Education Caucus (MECA) to discuss the needs of midwives teaching medical students and residents; the group has held a workshop annually over the last 4 years. In 2014, MECA workshop facilitators developed a toolkit to support and formalize the role of midwives involved in medical student and resident education. The MECA toolkit provides a roadmap for midwives beginning involvement and continuing or expanding the role of midwives in medical education. This article describes the history of midwives in medical education, the development and growth of MECA, and the resulting toolkit created to support and formalize the role of midwives as educators in medical student and resident education, as well as common challenges for the midwife in academic medicine. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health. © 2015 by the American College of Nurse-Midwives.

[Correlations between the dimensions of clinical learning environments from the perspective of medical residents].

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Hamui Sutton, Alicia; Flores Hernández, Fernando; Gutiérrez Barreto, Samuel; Castro Ramírez, Senyasen; Lavalle Montalvo, Carlos; Vilar Puig, Pelayo

2014-01-01

The aim of the present study was to establish correlations between the dimensions of clinical learning environments (ACA) considering variables like: health institutions, hospital offices, specialty, and year of residency. 4,189 doctors were evaluated through an online survey in 2012. The results revealed that the dimension of "educational processes" correlated best with others; specialties with the best ACA from the view of the medical residents were Internal Medicine and Surgery; and the third year residents had less favorable perceptions of their ACA. The pursuance of the academic program is relevant to physicians in training and teachers play an important role in the educational process.

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

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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.

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

Use of 360-degree assessment of residents in internal medicine in a Danish setting

DEFF Research Database (Denmark)

Allerup, Peter

2007-01-01

objectives to be assessed. We considered 22 of these suitable for assessment by 360-degrees assessment. METHODS: Medical departments of six hospitals contributed 42 interns to the study. Each resident was assessed by ten persons of whom one was a secretary, four were nurses and five senior doctors...

Association between periodontal diseases and systemic illnesses: A survey among internal medicine residents in Nigeria.

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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

Effects of Job Burnout and Emotional Labor on Objective Structured Clinical Examination Performance Among Interns and Residents in Taiwan.

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Wang, Chen-Yu; Chen, Jen-De; Wang, Chih-Hung; Wang, Jong-Yi; Tai, Chih-Jaan; Hsieh, Tsu-Yi; Chen, Der-Yuan

2017-01-01

Medical education faces challenges concerning job burnout and emotional labor among junior physicians, which poses a potential threat to the quality of medical care. Although studies have investigated job burnout and emotional labor among physicians, empirical research on the association between job burnout, emotional labor, and clinical performance is lacking. This study investigated the effects of job burnout and emotional labor on clinical performance by using the objective structured clinical examination (OSCE) scores of interns and residents. Specifically, this cross-sectional study utilized the Maslach Burnout Inventory and the Emotional Labor Questionnaire as measurement instruments. A total of 225 interns and residents in central Taiwan answered structured questionnaires before beginning their OSCE. The major statistical analysis method employed was logistic regression. After adjustment for covariates, first-year residents were less likely than other residents to obtain high OSCE scores. The odds of high OSCE performance among interns and residents with high interaction component scores in emotional labor were significantly higher than those with low interaction scores. A high score in the interaction dimension of emotional labor was associated with strong clinical performance. The findings suggest that interventions which motivate positive attitudes and increase interpersonal interaction skills among physicians should receive higher priority.

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.

Shadowing emergency medicine residents by medical education specialists to provide feedback on non-medical knowledge-based ACGME sub-competencies.

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Waterbrook, Anna L; Spear Ellinwood, Karen C; Pritchard, T Gail; Bertels, Karen; Johnson, Ariel C; Min, Alice; Stoneking, Lisa R

2018-01-01

Non-medical knowledge-based sub-competencies (multitasking, professionalism, accountability, patient-centered communication, and team management) are challenging for a supervising emergency medicine (EM) physician to evaluate in real-time on shift while also managing a busy emergency department (ED). This study examines residents' perceptions of having a medical education specialist shadow and evaluate their nonmedical knowledge skills. Medical education specialists shadowed postgraduate year 1 and postgraduate year 2 EM residents during an ED shift once per academic year. In an attempt to increase meaningful feedback to the residents, these specialists evaluated resident performance in selected non-medical knowledge-based Accreditation Council of Graduate Medical Education (ACGME) sub-competencies and provided residents with direct, real-time feedback, followed by a written evaluation sent via email. Evaluations provided specific references to examples of behaviors observed during the shift and connected these back to ACGME competencies and milestones. Twelve residents participated in this shadow experience (six post graduate year 1 and six postgraduate year 2). Two residents emailed the medical education specialists ahead of the scheduled shadow shift requesting specific feedback. When queried, five residents voluntarily requested their feedback to be included in their formal biannual review. Residents received milestone scores and narrative feedback on the non-medical knowledge-based ACGME sub-competencies and indicated the shadow experience and subsequent feedback were valuable. Medical education specialists who observe residents over the course of an entire shift and evaluate non-medical knowledge-based skills are perceived by EM residents to provide meaningful feedback and add valuable information for the biannual review process.

Loss of international medical experiences: knowledge, attitudes and skills at risk.

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Grudzen, Corita R; Legome, Eric

2007-11-28

Despite the great influence International Medical Experiences (IMs) can have on young physicians and their impact on patients and communities, they are not offered in all training programs and are at risk of being reduced in some due to stringent guidelines for funding of graduate medical education. IMs provide unique experiences in clinical, epidemiologic, cultural, and political arenas. From an educational perspective, they broaden a physician's differential diagnostic skills and introduce clinical entities rarely seen in the U.S. Time spent in developing countries emphasizes the importance of community health and increases cultural and linguistic competence. Experience working with the underserved during an IM has been shown to increase interest in volunteerism, humanitarian efforts, and work with underserved populations both in the US and abroad. IMs also afford physicians the opportunity to learn about the delivery of health care abroad and are associated with an increase in primary care specialty choice. It is time for the leaders in graduate medical education to prioritize international health opportunities. Leaders in academic medicine can press for changes in reimbursement patterns at the national level or special funds for international electives. Hospitals can set up separate accounts to help finance resident salaries and benefits while abroad. Individual departments must be flexible with resident schedules to allow elective time. Medical students and housestaff can organize and lobby larger organizations such as the American Medical Association (AMA), the American Association of Medical Colleges (AAMC), and specialty groups to make IMs universally accessible.

Source of learning basic clinical skills by medical interns Tehran University of Medical Sciences

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Meshkani Z

2004-07-01

Full Text Available Background: Effective clinical teaching is a major objective in general practitioner’s education at medical schools. Purpose: To identify the sources of clinical skills learning that medical student experience Methods: In this cross sectional study, interns of Tehran medical university who spent at least 12 months of their internship answered a questionnaire on the sources of clinical skills training. Chi2 test was used to examine the association of source of learning and students,’ specification such as sex, score of pre –internship exam, and marital status. Results: All 250 interns who were eligible participated. Over all 46.60% interns learned their clinical skills from residents or clinical teachers, 29.61% observed others performing the procedures, 16.25 learned the skills from hospital staff or nurses, 7.54% practiced their knowledge when confronted to an emergency situation Conclusion: Our results warrant a more attentive approach to clinical skills (specially procedural skills training Key words: LEARNING RESOURCES

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

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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.

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

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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

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

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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.

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

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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.

Trends in the Medical Knowledge and Clinical Competence of Graduates of Internal Medicine Residency Training Programs.

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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…

Impact of adding additional providers to resident workload and the resident experience on a medical consultation rotation.

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Fang, Michele; Linson, Eric; Suneja, Manish; Kuperman, Ethan F

2017-02-22

Excellence in Graduate Medical Education requires the right clinical environment with an appropriate workload where residents have enough patients to gain proficiency in medicine with optimal time for reflection. The Accreditation Council for Graduate Medical Education (ACGME) has focused more on work hours rather than workload; however, high resident workload has been associated with lower resident participation in education and fatigue-related errors. Recognizing the potential risks associated with high resident workload and being mindful of the costs of reducing resident workload, we sought to reduce residents' workload by adding an advanced practice provider (APP) to the surgical comanagement service (SCM) and study its effect on resident satisfaction and perceived educational value of the rotation. In Fiscal Year (FY) 2014 and 2015, an additional faculty member was added to the SCM rotation. In FY 2014, the faculty member was a staff physician, and in FY 2015, the faculty member was an APP.. Resident workload was assessed using billing data. We measured residents' perceptions of the rotation using an anonymous electronic survey tool. We compared FY2014-2015 data to the baseline FY2013. The number of patients seen per resident per day decreased from 8.0(SD 3.3) in FY2013 to 5.0(SD 1.9) in FY2014 (p value of the rotation (40.0%, 72.2%, 72.6% in FY2013, 2014, 2015 respectively, p perceived educational value and clinical experience of a medical consultation rotation.

Examining changes in certification/licensure requirements and the international medical graduate examinee pool.

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McKinley, Danette W; Hess, Brian J; Boulet, John R; Lipner, Rebecca S

2014-03-01

Changes in certification requirements and examinee characteristics are likely to influence the validity of the evidence associated with interpretations made based on test data. We examined whether changes in Educational Commission for Foreign Medical Graduates (ECFMG) certification requirements over time were associated with changes in internal medicine (IM) residency program director ratings and certification examination scores. Comparisons were made between physicians who were ECFMG-certified before and after the Clinical Skills Assessment (CSA) requirement. A multivariate analysis of covariance was conducted to examine the differences in program director ratings based on CSA cohort and whether the examinees emigrated for undergraduate medical education (national vs. international students). A univariate analysis of covariance was conducted to examine differences in scores from the American Board of Internal Medicine (ABIM) Internal Medicine Certification Examination. For both analyses, United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores were used as covariates. Results indicate that, of those certified by ECFMG between 1993 and 1997, 17 % (n = 1,775) left their country of citizenship for undergraduate medical education. In contrast, 38 % (n = 1,874) of those certified between 1999 and 2003 were international students. After adjustment by covariates, the main effect of cohort membership on the program director ratings was statistically significant (Wilks' λ = 0.99, F 5, 15391 = 19.9, P migration status was statistically significant and weak (Wilks' λ = 0.98, F 5,15391 = 45.3, P Internal Medicine Certification Examination scores based on whether or not CSA were required was statistically significant, although the magnitude of the association between these variables was very small. The findings suggest that the implementation of an additional evaluation of skills (e.g., history-taking, physical examination) as a

Developing a Communication Curriculum and Workshop for an Internal Medicine Residency Program.

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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

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

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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

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

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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.

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

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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

Teambuilding and Leadership Training in an Internal Medicine Residency Training Program

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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

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

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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.

Teledermatology as an educational tool for teaching dermatology to residents and medical students.

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Boyers, Lindsay N; Schultz, Amanda; Baceviciene, Rasa; Blaney, Susan; Marvi, Natasha; Dellavalle, Robert P; Dunnick, Cory A

2015-04-01

Although teledermatology (TD) is regarded as a tool to improve patient access to specialty healthcare, little has been done to evaluate its role in medical education. We describe the TD program at the Denver (CO) Department of Veterans Affairs Medical Center and evaluate its use as an educational tool for teaching dermatology to dermatology residents and medical students. Dermatology residents manage TD consultations and review all cases with a faculty preceptor; medical students participate as observers when possible. This study assessed dermatology resident (n=14) and medical student (n=16) perceptions of TD and its usefulness in teaching six core clinical competencies. Both residents (79%) and medical students (88%) "strongly agree" or "agree" that TD is an important educational tool. In general, medical students were slightly more satisfied than residents across all of the core competencies assessed except for patient care. Medical students and residents were most satisfied with the competencies of practice-based learning and improvement and medical knowledge, whereas they were least satisfied with those of interpersonal and communication skills and professionalism. Overall, TD is valued as a teaching tool for dermatology in the areas of patient care, medical knowledge, practice-based learning and improvement, and systems-based practice.

Fewer seniors from United States allopathic medical schools are filling pathology residency positions in the Main Residency Match, 2008-2017.

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Jajosky, Ryan Philip; Jajosky, Audrey N; Kleven, Daniel T; Singh, Gurmukh

2018-03-01

Some pathologists have observed that fewer trainees from US medical schools are entering pathology residency. This trend was measured and further explored using Main Residency Match (MRM) data from 2008 to 2017, obtained from the National Resident Matching Program (NRMP). Over the past decade, there was an increase of 93 (508 in 2008 versus 601 in 2017, an 18.3% increase) pathology positions offered in the MRM. However, the proportion of pathology residency positions filled in the MRM which were taken by trainees from US medical schools decreased from 77.7% to 50.1% over this timespan. This was primarily due to fewer seniors from US allopathic medical schools filling pathology positions in the MRM (298 in 2008 versus 216 in 2017, a 27.5% decrease). Compared to 14 other medical specialties, pathology had the largest decline in the proportion of residency positions filled in the MRM which were taken by seniors from US allopathic medical schools (63.8% in 2008 versus 39.6% in 2017). Furthermore, pathology now has the lowest percentage of residency positions filled in the MRM, which were taken by seniors from US allopathic medical schools. The primary reason for this decline was because fewer seniors from US allopathic medical schools participated in the MRM for pathology positions (326 in 2008 versus 232 in 2017, a 28.8% decrease); however, the underlying reasons for this decline are unknown. In conclusion, over the past decade, substantially fewer seniors from US allopathic medical schools sought/filled pathology residency positions in the MRM. These findings are relevant for pathology residency recruitment, especially in the context of a projected decline in US pathologist workforce. Copyright © 2017 Elsevier Inc. All rights reserved.

The impact of a medical procedure service on patient safety, procedure quality and resident training opportunities.

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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.

Characteristics of Successful Internal Medicine Resident Research Projects: Predictors of Journal Publication Versus Abstract Presentation.

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Atreya, Auras R; Stefan, Mihaela; Friderici, Jennifer L; Kleppel, Reva; Fitzgerald, Janice; Rothberg, Michael B

2018-02-06

To identify the characteristics of successful research projects at an internal medicine residency program with an established research curriculum. The authors collected data about all research projects initiated by or involving medicine residents from 2006 to 2013 at Baystate Medical Center, using departmental files and institutional review board applications. Resident and mentor characteristics were determined using personnel files and Medline searches. Using multivariable models, the authors identified predictors of successful completion of projects using adjusted prevalence ratios (PRs). The primary outcome was manuscript publication by resident and secondary outcome was either publication or regional/national presentation. Finally, residents were surveyed to identify barriers and/or factors contributing to project completion. Ninety-four research projects were identified: 52 (55.3%) projects achieved the primary outcome and 72 (76.5%) met the secondary outcome, with overlap between categories. Most study designs were cross-sectional (41, 43.6%) or retrospective cohort (30, 31.9%). After adjustment, utilization of the epidemiology/biostatistical core (PR = 2.09; 95% CI: 1.36, 3.21), established publication record of resident (PR = 1.54, 95% CI: 1.14, 2.07), and resident with U.S. medical education (PR = 1.39, 95% CI: 1.02, 1.90) were associated with successful completion of projects. Mentor publication record (PR = 3.13) did not retain significance due to small sample size. Most respondents (65%) cited "lack of time" as a major project barrier. Programs seeking to increase resident publications should consider an institutional epidemiology/biostatistical core available to all residency research projects, and residents should choose experienced mentors with a track record of publications.

Internal Medicine Residents' Perceptions of Team-Based Care and its Educational Value in the Continuity Clinic: A Qualitative Study.

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Soones, Tacara N; O'Brien, Bridget C; Julian, Katherine A

2015-09-01

In order to teach residents how to work in interprofessional teams, educators in graduate medical education are implementing team-based care models in resident continuity clinics. However, little is known about the impact of interprofessional teams on residents' education in the ambulatory setting. To identify factors affecting residents' experience of team-based care within continuity clinics and the impact of these teams on residents' education. This was a qualitative study of focus groups with internal medicine residents. Seventy-seven internal medicine residents at the University of California San Francisco at three continuity clinic sites participated in the study. Qualitative interviews were audiotaped and transcribed. The authors used a general inductive approach with sensitizing concepts in four frames (structural, human resources, political and symbolic) to develop codes and identify themes. Residents believed that team-based care improves continuity and quality of care. Factors in four frames affected their ability to achieve these goals. Structural factors included communication through the electronic medical record, consistent schedules and regular team meetings. Human resources factors included the presence of stable teams and clear roles. Political and symbolic factors negatively impacted team-based care, and included low staffing ratios and a culture of ultimate resident responsibility, respectively. Regardless of the presence of these factors or resident perceptions of their teams, residents did not see the practice of interprofessional team-based care as intrinsically educational. Residents' experiences practicing team-based care are influenced by many principles described in the interprofessional teamwork literature, including understanding team members' roles, good communication and sufficient staffing. However, these attributes are not correlated with residents' perceptions of the educational value of team-based care. Including residents in

National Undergraduate Medical Core Curriculum in Turkey: Evaluation of Residents

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Işıl İrem Budakoğlu

2014-03-01

Full Text Available Background: There is very little information available on self-perceived competence levels of junior medical doctors with regard to definitions by the National Core Curriculum (NCC for Undergraduate Medical Education. Aims: This study aims to determine the perceived level of competence of residents during undergraduate medical education within the context of the NCC. Study Design: Descriptive study. Methods: The survey was conducted between February 2010 and December 2011; the study population comprised 450 residents. Of this group, 318 (71% participated in the study. Self-assessment questionnaires on competencies were distributed and residents were asked to assess their own competence in different domains by scoring them on a scale of 1 to 10. Results: Nearly half of the residents reported insufficient experience of putting clinical skills into practice when they graduated. In the theoretical part of NCC, the lowest competency score was reported for health-care administration, while the determination of level of chlorine in water, delivering babies, and conducting forensic examinations had the lowest perceived levels of competency in the clinical skills domain. Conclusion: Residents reported low levels of perceived competency in skills they rarely performed outside the university hospital. They were much more confident in skills they performed during their medical education.

Transgender health care: improving medical students' and residents' training and awareness

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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

An "education for life" requirement to promote lifelong learning in an internal medicine residency program.

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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.

A Roadmap for Observership Programs in Psychiatry for International Medical Graduates

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Hamoda, Hesham M.; Sacks, Diane; Sciolla, Andres; Dewan, Mantosh; Fernandez, Antony; Gogineni, Rama Rao; Goldberg, Jeffrey; Kramer, Milton; Saunders, Ramotse; Sperber, Jacob; Rao, Nyapati R.

2012-01-01

Objective: International medical graduates (IMGs) constitute a significant proportion of the psychiatric workforce in the United States. Observership programs serve an important role in preparing IMGs for U.S. residency positions; yet there are limited resources with information available on establishing these observerships, and none specific to…

Perspectives on the changing healthcare system: teaching systems-based practice to medical residents

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Johanna Martinez

2013-09-01

Full Text Available Purpose: The Accreditation Council for Graduate Medical Education restructured its accreditation system to be based on educational outcomes in six core competencies. Systems-based practice is one of the six core competencies. The purpose of this report is to describe Weill Cornell Medical College's Internal Medicine Residency program curriculum for systems-based practice (SBP and its evaluation process. Methods: To examine potential outcomes of the POCHS curriculum, an evaluation was conducted, examining participants': (1 knowledge gain; (2 course ratings; and (3 qualitative feedback. Results: On average, there was a 19 percentage point increase in knowledge test scores for all three cohorts. The course was rated overall highly, receiving an average of 4.6 on a 1–5 scale. Lastly, the qualitative comments supported that the material is needed and valued. Conclusion: The course, entitled Perspectives on the Changing Healthcare System (POCHS and its evaluation process support that systems-based practice is crucial to residency education. The course is designed not only to educate residents about the current health care system but also to enable them to think critically about the risk and benefits of the changes. POCHS provides a framework for teaching and assessing this competency and can serve as a template for other residency programs looking to create or restructure their SBP curriculum.

Effect of didactic lectures on obesity documentation and counseling among internal medicine residents.

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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.

Evaluation of potentially inappropriate medications among older residents of Malaysian nursing homes.

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Chen, Li Li; Tangiisuran, Balamurugan; Shafie, Asrul Akmal; Hassali, Mohamed Azmi Ahmad

2012-08-01

There is an increasing evidence of medicines related issues such as inappropriate prescribing among older people. Inappropriate prescribing is an important risk factor for adverse drug reactions and hospitalizations in the older people. To assess and characterize the prevalence of Potentially Inappropriate Medications (PIMs) in nursing home care in Malaysia as defined by Screening Tool of Older Peoples Prescriptions (STOPP) and Beers criteria. Four Nursing Homes situated in Penang, Malaysia. A multicenter and cross-sectional study was conducted over 2 months period at four large non-governmental organizations nursing homes in Penang, Malaysia. The study population included older residents (≥65 years old) taking at least one medication. Residents who had been diagnosed with dementia or taking anti dementia drugs, delirium, too frail or refused to give consent were excluded. Demographic, clinical data and concurrent medications were collected through direct interview and also by reviewing medical records. STOPP and Beers criteria were applied in the medical review to screen for PIMs. Potentially Inappropriate Medication using STOPP and Beers criteria. Two hundred eleven residents were included in the study with the median age of 77 (inter quartile range (IQR) 72-82) years. Median number of prescription medicines was 4 (IQR 1-14). STOPP identified less residents (50 residents, 23.7 %) being prescribed on PIMs compared with Beers criteria (69 residents, 32.7 %) (p older residents living in the nursing homes and are associated with number of medications and longer nursing home stay. Further research is warranted to study the impact of PIMs towards health related outcomes in these elderly.

International students in United States’ medical schools: does the medical community know they exist?

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Jashodeep Datta

2012-06-01

Full Text Available Background: Matriculation of international students to United States’ (US medical schools has not mirrored the remarkable influx of these students to other US institutions of higher education. Methods: While these students’ numbers are on the rise, the visibility for their unique issues remains largely ignored in the medical literature. Results: These students are disadvantaged in the medical school admissions process due to financial and immigration-related concerns, and academic standards for admittance also continue to be significantly higher compared with their US-citizen peers. Furthermore, it is simply beyond the mission of many medical schools – both public and private – to support international students’ education, especially since federal, state-allocated or institutional funds are limited and these institutions have a commitment to fulfill the healthcare education needs of qualified domestic candidates. In spite of these obstacles, a select group of international students do gain admission to US medical schools and, upon graduation, are credentialed equally as their US-citizen counterparts by the Accreditation Council for Graduate Medical Education (ACGME. However, owing to their foreign citizenship, these students have visa requirements for post-graduate training that may adversely impact their candidacy for residency placement. Conclusion: By raising such issues, this article aims to increase the awareness of considerations pertinent to this unique population of medical students. The argument is also made to support continued recruitment of international students to US medical schools in spite of these impediments. In our experience, these students are not only qualified to tackle the rigors of a US medical education, but also enrich the cultural diversity of the medical student body. Moreover, these graduates could effectively complement the efforts to augment US physician workforce diversity while contributing to

Altering workplace attitudes for resident education (A.W.A.R.E.): discovering solutions for medical resident bullying through literature review.

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Leisy, Heather B; Ahmad, Meleha

2016-04-27

Physicians-in-training are challenged every day with grueling academic requirements, job strain, and patient safety concerns. Residency shapes the skills and values that will percolate to patient care and professional character. Unfortunately, impediments to the educational process due to medical resident mistreatment by bullying remain highly prevalent in training today. A PubMed literature review was undertaken using key terms to help define resident mistreatment by bullying, determine its prevalence, identify its potential causes and sequelae, and find suggestions for changing this detrimental culture of medical training. We identified 62 relevant articles. The most frequently noted form of mistreatment was verbal abuse, with the most common perpetrators being fellow physicians of higher hierarchical power. Mistreatment exists due to its cyclical nature and the existing culture of medical training. These disruptive behaviors affect the wellbeing of both medical residents and patients. This article highlights the importance of creating systems that educate physicians-in-training about professional mistreatment by bullying and the imperative in recognizing and correcting these abuses. Resident bullying leads to increased resident stress, decreased resident wellbeing as well as risks to patient safety and increased healthcare costs. Solutions include education of healthcare team members, committee creation, regulation of feedback, and creation of a zero-tolerance policy focused on the health of both patients and residents. Altering workplace attitudes will diminish the detrimental effects that bullying has on resident training.

The desirability of education in didactic skills according to medical interns.

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Kloek, Anne T; Verbakel, Joshua R A; Bernard, Simone E; Evenboer, Januska; Hendriks, Eef J; Stam, Hanneke

2012-12-01

Since all doctors at some point in their career will be faced with their role as a teacher, it appears desirable that future doctors are educated in didactic skills. At present, however, there are no formal opportunities for developing didactic skills at the majority of Dutch medical faculties. The main question of this study is: How do medical interns perceive the quality and quantity of their education in didactic skills? The Dutch Association for Medical Interns (LOCA) ran a national survey among 1,008 medical interns that measured the interns' self-assessed needs for training in didactic skills during medical school. Almost 80 % of the respondents argue that the mastery of didactic skills composes an essential competency for doctors, with the skill of providing adequate feedback considered to be the most important didactic quality for doctors. Of the respondents, 41 % wish to be educated in didactic skills, both during their medical undergraduate degree and during their subsequent training to become a resident. Teaching while being observed and receiving feedback in this setting is regarded as a particularly valuable didactic method by 74 % of the medical interns. Of the respondents, 82 % would invest time to follow training for the development of didactic skills if it was offered. Medical interns stress the importance of doctors' didactic skills during their clinical internships. Compared with current levels, most interns desire increased attention to the formal development of didactic skills during medical school. Considering the importance of didactic skills and the need for more extensive training, the LOCA advises medical faculties to include more formal didactic training in the medical curriculum.

Shadowing emergency medicine residents by medical education specialists to provide feedback on non-medical knowledge-based ACGME sub-competencies

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Waterbrook AL

2018-05-01

Full Text Available Anna L Waterbrook,1 Karen C Spear Ellinwood,2 T Gail Pritchard,3 Karen Bertels,1 Ariel C Johnson,4 Alice Min,1 Lisa R Stoneking1 1Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA; 2Department of Obstetrics and Gynecology, The University of Arizona College of Medicine, Tucson, AZ, USA; 3Department of Pediatrics, The University of Arizona College of Medicine, Tucson, AZ, USA; 4College of Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA Objective: Non-medical knowledge-based sub-competencies (multitasking, professionalism, accountability, patient-centered communication, and team management are challenging for a supervising emergency medicine (EM physician to evaluate in real-time on shift while also managing a busy emergency department (ED. This study examines residents’ perceptions of having a medical education specialist shadow and evaluate their nonmedical knowledge skills.Methods: Medical education specialists shadowed postgraduate year 1 and postgraduate year 2 EM residents during an ED shift once per academic year. In an attempt to increase meaningful feedback to the residents, these specialists evaluated resident performance in selected non-medical knowledge-based Accreditation Council of Graduate Medical Education (ACGME sub-competencies and provided residents with direct, real-time feedback, followed by a written evaluation sent via email. Evaluations provided specific references to examples of behaviors observed during the shift and connected these back to ACGME competencies and milestones.Results: Twelve residents participated in this shadow experience (six post graduate year 1 and six postgraduate year 2. Two residents emailed the medical education specialists ahead of the scheduled shadow shift requesting specific feedback. When queried, five residents voluntarily requested their feedback to be included in their formal biannual review. Residents received

The impact of public hospital closure on medical and residency education: implications and recommendations.

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Walker, Kara Odom; Calmes, Daphne; Hanna, Nancy; Baker, Richard

2008-12-01

Challenges around safety-net hospital closure have impacted medical student and resident exposure to urban public healthcare sites that may influence their future practice choices. To assess the impact of the closure of a public safety-net teaching hospital for the clinical medical education of Charles Drew University medical students and residents. Retrospective cohort study of medical students' and residents' and clinical placement into safety-net experiences after the closure of the primary teaching hospital. The hospital closure impacted both medical student and residency training experiences. Only 71% (17/24) of medical student rotations and 13% (23/180) of residents were maintained at public safety-net clinical sittings. The closure of the public safety-net hospital resulted in the loss of 36% of residency training spots sponsored by historically black medical schools in the United States and an even larger negative impact on the number of physicians training in underserved urban areas of Los Angeles County. While the medical educational program changes undertaken in the wake of hospital closure have negatively affected the immediate clinical educational experiences of medical students and residents, it remains to be seen whether the training site location changes will alter their long-term preferences in specialty choice and practice location.

Interrelationships between romance, life quality, and medical training of female residents.

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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.

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.

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

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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.

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

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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.

Knowledge of HIV Testing Guidelines Among US Internal Medicine Residents: A Decade After the Centers for Disease Control and Prevention's Routine HIV Testing Recommendations.

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Dandachi, Dima; Dang, Bich N; Wilson Dib, Rita; Friedman, Harvey; Giordano, Thomas

2018-05-01

Ten years after the Centers for Disease Control and Prevention recommended universal HIV screening, rates remain low. Internal medicine residents are the front-line medical providers for large groups of patients. We evaluated the knowledge of internal medicine residents about HIV testing guidelines and examined adherence to universal HIV testing in an outpatient setting. A cross-sectional survey of internal medicine residents at four residency programs in Chicago was conducted from January to March 2016. Aggregate data on HIV screening were collected from 35 federally qualified community health centers in the Chicago area after inclusion of an HIV testing best practice alert in patients' electronic medical records. Of the 192 residents surveyed, 130 (68%) completed the survey. Only 58% were aware of universal HIV screening and 49% were aware that Illinois law allows for an opt-out HIV testing strategy. Most of the residents (64%) ordered no more than 10 HIV tests in 6 months. The most frequently reported barriers to HIV testing were deferral because of urgent care issues, lack of time, and the perception that patients were uncomfortable discussing HIV testing. From July 2015 to February 2016, the average HIV testing adherence rate in the 35 health centers was 18.2%. More effort is needed to change HIV testing practices among internal medicine residents so that they will adopt this approach in their future clinical practice. Improving knowledge about HIV testing and addressing other HIV testing barriers are essential for such a successful change.

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

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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...

Challenges Facing Medical Residents' Satisfaction in the Middle East: A Report From United Arab Emirates.

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Abdulrahman, Mahera; Qayed, Khalil I; AlHammadi, Hisham H; Julfar, Adnan; Griffiths, Jane L; Carrick, Frederick R

2015-01-01

PHENOMENON: Medical residents' satisfaction with the quality of training for medical residency training specialists is one of the core measures of training program success. It will also therefore contribute to the integrity of healthcare in the long run. Yet there is a paucity of research describing medical residents' satisfaction in the Middle East, and there are no published studies that measure the satisfaction of medical residents trained within the United Arab Emirates (UAE). This makes it difficult to develop a quality residency training program that might meet the needs of both physicians and society. The authors designed a questionnaire to assess medical residents' satisfaction with the Dubai residency training program in order to identify insufficiencies in the training, clinical, and educational aspects. The survey was a self-report questionnaire composed of different subscales covering sociodemographic and educational/academic profile of the residents along with their overall satisfaction of their training, curriculum, work environment, peer teamwork, and their personal opinion on their medical career. Respondents showed a substantial level of satisfaction with the residency training. The vast majority of residents (80%, N = 88) believe that their residency program curriculum and rotation was "good," "very good," or "excellent." Areas of dissatisfaction included salary, excessive paperwork during rotations, and harassment. INSIGHTS: This is the first report that studies the satisfaction of medical residents in all specialties in Dubai, UAE. Our findings provide preliminary evidence on the efficiency of different modifications applied to the residency program in UAE. To our knowledge, there has not been any previous study in the Middle East that has analyzed this aspect of medical residents from different specialties. The authors believe that this report can be used as a baseline to monitor the effectiveness of interventions applied in the future toward

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

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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.

Medical humanities: a resident doctor's perspective.

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Pauranik, Anvita

2012-01-01

The barrage of competitive examinations, overwork, sleep deprivation, and the pressure of expectations all combine to destroy the dreams that resident doctors have when they start medical school. The empathy they had before entering this field fades away, and they eventually become insensitive to their patients. Medical humanities may be the means to halt this trend. Sensitising young minds, using the arts, literature, history and lessons on social issues, may bring about a paradigm shift in these doctors' outlook towards their patients. However, for the humanities to be integrated into medical education, the current curriculum must be modified and made more clinically and socially relevant. Further, the humanities cannot be taught in lecture halls; they need to be integrated into all aspects of medical school. For this, the medical school faculty should be sensitised to, and trained in, humanities education.

Automated medical resident rotation and shift scheduling to ensure quality resident education and patient care.

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Smalley, Hannah K; Keskinocak, Pinar

2016-03-01

At academic teaching hospitals around the country, the majority of clinical care is provided by resident physicians. During their training, medical residents often rotate through various hospitals and/or medical services to maximize their education. Depending on the size of the training program, manually constructing such a rotation schedule can be cumbersome and time consuming. Further, rules governing allowable duty hours for residents have grown more restrictive in recent years (ACGME 2011), making day-to-day shift scheduling of residents more difficult (Connors et al., J Thorac Cardiovasc Surg 137:710-713, 2009; McCoy et al., May Clin Proc 86(3):192, 2011; Willis et al., J Surg Edu 66(4):216-221, 2009). These rules limit lengths of duty periods, allowable duty hours in a week, and rest periods, to name a few. In this paper, we present two integer programming models (IPs) with the goals of (1) creating feasible assignments of residents to rotations over a one-year period, and (2) constructing night and weekend call-shift schedules for the individual rotations. These models capture various duty-hour rules and constraints, provide the ability to test multiple what-if scenarios, and largely automate the process of schedule generation, solving these scheduling problems more effectively and efficiently compared to manual methods. Applying our models on data from a surgical residency program, we highlight the infeasibilities created by increased duty-hour restrictions placed on residents in conjunction with current scheduling paradigms.

A time-efficient web-based teaching tool to improve medical knowledge and decrease ABIM failure rate in select residents.

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Drake, Sean M; Qureshi, Waqas; Morse, William; Baker-Genaw, Kimberly

2015-01-01

The American Board of Internal Medicine (ABIM) exam's pass rate is considered a quality measure of a residency program, yet few interventions have shown benefit in reducing the failure rate. We developed a web-based Directed Reading (DR) program with an aim to increase medical knowledge and reduce ABIM exam failure rate. Internal medicine residents at our academic medical center with In-Training Examination (ITE) scores ≤ 35 th percentile from 2007 to 2013 were enrolled in DR. The program matches residents to reading assignments based on their own ITE-failed educational objectives and provides direct electronic feedback from their teaching physicians. ABIM exam pass rates were analyzed across various groups between 2002 and 2013 to examine the effect of the DR program on residents with ITE scores ≤ 35 percentile pre- (2002-2006) and post-intervention (2007-2013). A time commitment survey was also given to physicians and DR residents at the end of the study. Residents who never scored ≤ 35 percentile on ITE were the most likely to pass the ABIM exam on first attempt regardless of time period. For those who ever scored ≤ 35 percentile on ITE, 91.9% of residents who participated in DR passed the ABIM exam on first attempt vs 85.2% of their counterparts pre-intervention (p ITE were more likely to fail ABIM exam on first attempt, those who participated in the DR program were less likely to fail than the historical control counterparts. The web-based teaching method required little time commitment by faculty.

Evaluation of a Substance Use Disorder Curriculum for Internal Medicine Residents

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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…

The relationship between work and home characteristics and work engagement in medical residents.

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Verweij, Hanne; van Hooff, Madelon L M; van der Heijden, Frank M M A; Prins, Jelle T; Lagro-Janssen, Antoine L M; van Ravesteijn, Hiske; Speckens, Anne E M

2017-08-01

Work engagement is important for medical residents and the healthcare organizations they work for. However, relatively little is known about the specific predictors of work engagement in medical residents. Therefore, we examined the associations of work and home characteristics, and work-home interference with work engagement in male and female residents. This study was conducted on a nationwide sample of medical residents. In 2005, all Dutch medical residents (n = 5245) received a self-report questionnaire. Path analysis was used to examine the associations between the potential predictors and work engagement. In total, 2115 (41.1%) residents completed the questionnaire. Job characteristics, home characteristics and work-home interference were associated with work engagement. Important positive contributing factors of work engagement were opportunities for job development, mental demands at work, positive work-home interference and positive home-work interference. Important negative contributing factors were emotional demands at work and negative home-work interference. The influence of these factors on work engagement was similar in male and female residents. Opportunities for job development and having challenging work are of high relevance in enhancing work engagement. Furthermore, interventions that teach how to deal skilfully with emotional demands at work and home-work interference are expected to be the most effective interventions to enhance work engagement in medical residents.

Narrative reflective practice in medical education for residents: composing shifting identities.

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Clandinin, Jean; Cave, Marie Thérèse; Cave, Andrew

2011-01-01

As researchers note, medical educators need to create situations to work with physicians in training to help them attend to the development of their professional identities. While there is a call for such changes to be included in medical education, educational approaches that facilitate attention to the development of medical students' professional identities, that is, who they are and who they are becoming as physicians, are still under development. One pedagogical strategy involves narrative reflective practice as a way to develop physician identity. Using this approach, medical residents first write narrative accounts of their experiences with patients in what are called "parallel charts". They then engage in a collaborative narrative inquiry within a sustained inquiry group of other residents and two researcher/facilitators (one physician, one narrative researcher). Preliminary studies of this approach are underway. Drawing on the experiences of one medical resident in one such inquiry group, we show how this pedagogical strategy enables attending to physician identity making.

Preparing Emergency Medicine Residents to Disclose Medical Error Using Standardized Patients

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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

Narrative reflective practice in medical education for residents: composing shifting identities

Directory of Open Access Journals (Sweden)

Jean Clandinin

2010-12-01

Full Text Available Jean Clandinin1, Marie Thérèse Cave2, Andrew Cave21Center for Research for Teacher Education and Development, University of Alberta, Edmonton, Alberta, Canada; 2Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, CanadaAbstract: As researchers note, medical educators need to create situations to work with physicians in training to help them attend to the development of their professional identities. While there is a call for such changes to be included in medical education, educational approaches that facilitate attention to the development of medical students' professional identities, that is, who they are and who they are becoming as physicians, are still under development. One pedagogical strategy involves narrative reflective practice as a way to develop physician identity. Using this approach, medical residents first write narrative accounts of their experiences with patients in what are called "parallel charts". They then engage in a collaborative narrative inquiry within a sustained inquiry group of other residents and two researcher/facilitators (one physician, one narrative researcher. Preliminary studies of this approach are underway. Drawing on the experiences of one medical resident in one such inquiry group, we show how this pedagogical strategy enables attending to physician identity making.Keywords: physician identity formation, residency

International medical students and migration: the missing dimension in Australian workforce planning?

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Hawthorne, Lesleyanne; Hamilton, Jan

2010-09-06

To investigate the potential contribution of international medical students at Australian universities to the Australian medical workforce. A prospective survey in 2006-2007 of 619 international medical students in their final 2 years of undergraduate- and graduate-entry medical courses across eight Australian universities, followed by a 2009 survey of 88 international medical graduates of the University of Melbourne (most of whom were respondents of the earlier survey), assessing the correlation between students' intended place of internship and their actual place of internship. The survey respondents' preferred internship location; the proportion of respondents who intended to remain in practice in Australia long term; and correlation between respondents' intended internship locations and actual placements in their first postgraduate year. Of the 619 international medical students surveyed in 2006, 358 (58%) responded. Most planned to undertake Australian internships and seek permanent-resident status, although a third were undecided about their long-term plans. Nationality was a highly significant variable. Most preferred city rather than regional or rural training locations and expressed interest in migrating to Australia. The 2009 survey of the University of Melbourne's 2008 medical graduates showed a high correlation between students' plans in their last two years of study and outcomes in their first postgraduate year, with 73% accepting Victorian internships for 2009. International medical students studying at Australian universities represent a substantial and highly acceptable medical workforce resource for Australia. Their requirement for internships needs to be considered in, and should influence, infrastructure planning.

Medical Physics Residency Consortium: collaborative endeavors to meet the ABR 2014 certification requirements

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Parker, Brent C.; Duhon, John; Yang, Claus C.; Wu, H. Terry; Hogstrom, Kenneth R.

2014-01-01

In 2009, Mary Bird Perkins Cancer Center (MBPCC) established a Radiation Oncology Physics Residency Program to provide opportunities for medical physics residency training to MS and PhD graduates of the CAMPEP‐accredited Louisiana State University (LSU)‐MBPCC Medical Physics Graduate Program. The LSU‐MBPCC Program graduates approximately six students yearly, which equates to a need for up to twelve residency positions in a two‐year program. To address this need for residency positions, MBPCC has expanded its Program by developing a Consortium consisting of partnerships with medical physics groups located at other nearby clinical institutions. The consortium model offers the residents exposure to a broader range of procedures, technology, and faculty than available at the individual institutions. The Consortium institutions have shown a great deal of support from their medical physics groups and administrations in developing these partnerships. Details of these partnerships are specified within affiliation agreements between MBPCC and each participating institution. All partner sites began resident training in 2011. The Consortium is a network of for‐profit, nonprofit, academic, community, and private entities. We feel that these types of collaborative endeavors will be required nationally to reach the number of residency positions needed to meet the 2014 ABR certification requirements and to maintain graduate medical physics training programs. PACS numbers: 01.40.Fk, 01.40.gb PMID:24710434

[Learning styles in medical residents and their professors of a pediatric hospital.

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Juárez-Muñoz, Irina Elizabeth; Gómez-Negrete, Alonso; Varela-Ruiz, Margarita; Mejía-Aranguré, Juan Manuel; Mercado-Arellano, José Agustín; Sciandra-Rico, Martha Minerva; Matute-González, Mario Manuel

2013-01-01

Background: the learning styles are cognitive, emotional, and psychological characteristics, which function as relatively stable indicators of how teachers and students perceive, interact, and respond to their learning environments. Knowing students' styles allows teachers to have tools to improve medical education. Our objective was to identify learning styles in pediatric residents and professors from a pediatric hospital. Methods: a learning styles questionnaire was applied to residents and theirs professors; data was analyzed in SPSS 12 software. Results: the dominant learning style in pediatric residents was reflexive and for professors was theoretical. There wasn't any difference between sexes or between medical or surgical specialities. There was more correlation between professors and residents when there was an increase in training time. Conclusions: the learning styles between professors and residents are different, especially at the beginning of the medical specialty courses; that's why it is necessary to realize a confrontation between the students' learning styles and teaching methods used by professors to improve significant learning. To know learning styles gives residents an important alternative to find a better study strategy.

WE-D-204-00: Session in Memory of Franca Kuchnir: Excellence in Medical Physics Residency Education

Energy Technology Data Exchange (ETDEWEB)

NONE

2016-06-15

Speakers in this session will present overview and details of a specific rotation or feature of their Medical Physics Residency Program that is particularly exceptional and noteworthy. The featured rotations include foundational topics executed with exceptional acumen and innovative educational rotations perhaps not commonly found in Medical Physics Residency Programs. A site-specific clinical rotation will be described, where the medical physics resident follows the physician and medical resident for two weeks into patient consultations, simulation sessions, target contouring sessions, planning meetings with dosimetry, patient follow up visits, and tumor boards, to gain insight into the thought processes of the radiation oncologist. An incident learning rotation will be described where the residents learns about and practices evaluating clinical errors and investigates process improvements for the clinic. The residency environment at a Canadian medical physics residency program will be described, where the training and interactions with radiation oncology residents is integrated. And the first month rotation will be described, where the medical physics resident rotates through the clinical areas including simulation, dosimetry, and treatment units, gaining an overview of the clinical flow and meeting all the clinical staff to begin the residency program. This session will be of particular interest to residency programs who are interested in adopting or adapting these curricular ideas into their programs and to residency candidates who want to learn about programs already employing innovative practices. Learning Objectives: To learn about exceptional and innovative clinical rotations or program features within existing Medical Physics Residency Programs. To understand how to adopt/adapt innovative curricular designs into your own Medical Physics Residency Program, if appropriate.

WE-D-204-00: Session in Memory of Franca Kuchnir: Excellence in Medical Physics Residency Education

International Nuclear Information System (INIS)

2016-01-01

Speakers in this session will present overview and details of a specific rotation or feature of their Medical Physics Residency Program that is particularly exceptional and noteworthy. The featured rotations include foundational topics executed with exceptional acumen and innovative educational rotations perhaps not commonly found in Medical Physics Residency Programs. A site-specific clinical rotation will be described, where the medical physics resident follows the physician and medical resident for two weeks into patient consultations, simulation sessions, target contouring sessions, planning meetings with dosimetry, patient follow up visits, and tumor boards, to gain insight into the thought processes of the radiation oncologist. An incident learning rotation will be described where the residents learns about and practices evaluating clinical errors and investigates process improvements for the clinic. The residency environment at a Canadian medical physics residency program will be described, where the training and interactions with radiation oncology residents is integrated. And the first month rotation will be described, where the medical physics resident rotates through the clinical areas including simulation, dosimetry, and treatment units, gaining an overview of the clinical flow and meeting all the clinical staff to begin the residency program. This session will be of particular interest to residency programs who are interested in adopting or adapting these curricular ideas into their programs and to residency candidates who want to learn about programs already employing innovative practices. Learning Objectives: To learn about exceptional and innovative clinical rotations or program features within existing Medical Physics Residency Programs. To understand how to adopt/adapt innovative curricular designs into your own Medical Physics Residency Program, if appropriate.

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

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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

Feasibility and Usability of Tele-interview for Medical Residency Interview

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Ali Pourmand

2017-12-01

Full Text Available Every year in the United States, medical students and residency programs dedicate millions of dollars to the residency matching process. On-site interviews for training positions involve tremendous financial investment, and time spent detracts from educational pursuits and clinical responsibilities. Students are usually required to fund their own travel and accommodations, adding additional financial burdens to an already costly medical education. Similarly, residency programs allocate considerable funds to interview-day meals, tours, staffing, and social events. With the rapid onslaught of innovations and advancements in the field of telecommunication, technology has become ubiquitous in the practice of medicine. Internet applications have aided our ability to deliver appropriate, evidence-based care at speeds previously unimagined. Wearable medical tech allows physicians to monitor patients from afar, and telemedicine has emerged as an economical means by which to provide care to all corners of the world. It is against this backdrop that we consider the integration of technology into the residency application process. This article aims to assess the implementation of technology in the form of web-based interviewing as a viable means by which to reduce the costs and productivity losses associated with traditional in-person interview days.

Feasibility and Usability of Tele-interview for Medical Residency Interview

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Pourmand, Ali; Lee, Hayoung; Fair, Malika; Maloney, Kaylah; Caggiula, Amy

2018-01-01

Every year in the United States, medical students and residency programs dedicate millions of dollars to the residency matching process. On-site interviews for training positions involve tremendous financial investment, and time spent detracts from educational pursuits and clinical responsibilities. Students are usually required to fund their own travel and accommodations, adding additional financial burdens to an already costly medical education. Similarly, residency programs allocate considerable funds to interview-day meals, tours, staffing, and social events. With the rapid onslaught of innovations and advancements in the field of telecommunication, technology has become ubiquitous in the practice of medicine. Internet applications have aided our ability to deliver appropriate, evidence-based care at speeds previously unimagined. Wearable medical tech allows physicians to monitor patients from afar, and telemedicine has emerged as an economical means by which to provide care to all corners of the world. It is against this backdrop that we consider the integration of technology into the residency application process. This article aims to assess the implementation of technology in the form of web-based interviewing as a viable means by which to reduce the costs and productivity losses associated with traditional in-person interview days. PMID:29383060

A comparison of medical students', residents' and tutors' attitudes towards communication skills learning.

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Molinuevo, Beatriz; Aradilla-Herrero, Amor; Nolla, Maria; Clèries, Xavier

2016-01-01

The consensus about the importance of communication skills in patient-care does not guarantee that students and faculty perceive the usefulness of these skills. This study evaluated and compared medical students', residents' and tutors' attitudes towards learning communication skills, and examined the association with gender and year of residency. We conducted a cross-sectional survey with 492 participants (282 second-year students, 131 residents and 79 tutors). They completed the Communication Skills Attitude Scale (CSAS) and demographic/educational information. In general, participants showed positive attitudes towards learning communication skills. Medical students, residents and tutors did not differ on the Positive Attitudes Scale (CSAS-PAS). Residents scored higher than medical students on the Negative Attitudes Scale (CSAS-NAS) (P communication skills an essential component for clinical practice and they agree about the need to learn these communication skills. Attention should be paid to measuring attitudes at all three levels of medical education in the design of communication skills courses.

Comparison of Burnout among Medical Residents before and after the Implementation of Work Hours Limits

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Martini, Shahm; Arfken, Cynthia L.; Balon, Richard

2006-01-01

Objective: The authors assess whether implementation of work hour limits is associated with a lower prevalence of medical resident burnout. Method: A survey was mailed to medical residents in different medical specialties at one university. Results: Somewhat lower burnout prevalence was reported among residents after implementation of work hour…

Assessing pediatrics residents' mathematical skills for prescribing medication: a need for improved training.

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Glover, Mark L; Sussmane, Jeffrey B

2002-10-01

To evaluate residents' skills in performing basic mathematical calculations used for prescribing medications to pediatric patients. In 2001, a test of ten questions on basic calculations was given to first-, second-, and third-year residents at Miami Children's Hospital in Florida. Four additional questions were included to obtain the residents' levels of training, specific pediatrics intensive care unit (PICU) experience, and whether or not they routinely double-checked doses and adjusted them for each patient's weight. The test was anonymous and calculators were permitted. The overall score and the score for each resident class were calculated. Twenty-one residents participated. The overall average test score and the mean test score of each resident class was less than 70%. Second-year residents had the highest mean test scores, although there was no significant difference between the classes of residents (p =.745) or relationship between the residents' PICU experiences and their exam scores (p =.766). There was no significant difference between residents' levels of training and whether they double-checked their calculations (p =.633) or considered each patient's weight relative to the dose prescribed (p =.869). Seven residents committed tenfold dosing errors, and one resident committed a 1,000-fold dosing error. Pediatrics residents need to receive additional education in performing the calculations needed to prescribe medications. In addition, residents should be required to demonstrate these necessary mathematical skills before they are allowed to prescribe medications.

Geriatrics Curricula for Internal and Family Medicine Residents: Assessing Study Quality and Learning Outcomes.

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Cheng, Huai Yong; Davis, Molly

2017-02-01

Prior reviews of geriatrics curricula for internal medicine (IM) and family medicine (FM) residents have not evaluated study quality or assessed learning objectives or specific IM or FM competencies. This review of geriatrics curricula for IM and FM residents seeks to answer 3 questions: (1) What types of learning outcomes were measured? (2) How were learning outcomes measured? and (3) What was the quality of the studies? We evaluated geriatrics curricula that reported learning objectives or competencies, teaching methods, and learning outcomes, and those that used a comparative design. We searched PubMed and 4 other data sets from 2003-2015, and assessed learning outcomes, outcome measures, and the quality of studies using the Medical Education Research Study Quality Instrument (MERSQI) and Best Evidence Medical Education (BEME) methods. Fourteen studies met inclusion criteria. Most curricula were intended for IM residents in the inpatient setting; only 1 was solely dedicated to FM residents. Median duration was 1 month, and minimum geriatrics competencies covered were 4. Learning outcomes ranged from Kirkpatrick levels 1 to 3. Studies that reported effect size showed a considerable impact on attitudes and knowledge, mainly via pretests and posttests. The mean MERSQI score was 10.5 (range, 8.5-13) on a scale of 5 (lowest quality) to 18 (highest quality). Few geriatrics curricula for IM and FM residents that included learning outcome assessments were published recently. Overall, changes in attitudes and knowledge were sizeable, but reporting was limited to low to moderate Kirkpatrick levels. Study quality was moderate.

Relationship between occupational stress and depressive mood among interns and residents in a tertiary hospital, Seoul, Korea.

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Kim, Keon; Lee, Sunhwa; Choi, Yoon Hee

2015-06-01

Occupational stress can have a harmful effect on the individual both physically and psychologically. In Korea, occupational stress of physician is rarely demonstrated. Although it is well reported that physicians tend to have a high incidence of minor psychiatric disorders, the magnitude of the problem remains unclear. Interns and residents are thought to be under substantial amount of stress, and tend to have psychiatric disorder. In this paper, we aimed to evaluate the relationship between the occupational stress and depression of residents. The participants of this study were surgical and medical residents in a tertiary hospital in Korea. For measurement of occupational stress, we used an occupational stress scale. In addition, to evaluate the prevalence of depression, we used the Beck Depression Inventory. Female doctors showed higher degree of occupational stress than the males. The interns and chief residents showed higher degree of occupational stress than the other residents. Interestingly, in this study, most of the participants experienced a depressive mood. Compared with the general population, job demand and culture of workplace were high. Occupational stress was the only significant predictor of a depressive mood. Hospital residents experience a high degree of occupational stress leading to a depressed mood due to various risk factors. Therefore, it is essential to recognize the occupational stress of residents early, to encourage positive competition and peer and social support, and to help improve the residents' ability to cope with stress.

Measuring psychological flexibility in medical students and residents: a psychometric analysis

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Christie L. Palladino

2013-08-01

Full Text Available Purpose: Psychological flexibility involves mindful awareness of our thoughts and feelings without allowing them to prohibit acting consistently with our values and may have important implications for patient-centered clinical care. Although psychological flexibility appears quite relevant to the training and development of health care providers, prior research has not evaluated measures of psychological flexibility in medical learners. Therefore, we investigated the validity of our learners’ responses to three measures related to psychological flexibility. Methods: Fourth-year medical students and residents (n=275 completed three measures of overlapping aspects of psychological flexibility: (1 Acceptance and Action Questionnaire-II (AAQ-II; (2 Cognitive Fusion Questionnaire (CFQ; and (3 Mindful Attention and Awareness Questionnaire (MAAS. We evaluated five aspects of construct validity: content, response process, internal structure, relationship with other variables, and consequences. Results: We found good internal consistency for responses on the AAQ (α=0.93, MAAS (α=0.92, and CFQ (α=0.95. Factor analyses demonstrated a reasonable fit to previously published factor structures. As expected, scores on all three measures were moderately correlated with one another and with a measure of life satisfaction (p<0.01. Conclusion: Our findings provide preliminary evidence supporting validity of the psychological flexibility construct in a medical education sample. As psychological flexibility is a central concept underlying self-awareness, this work may have important implications for clinical training and practice.

What influences national and foreign physicians' geographic distribution? An analysis of medical doctors' residence location in Portugal.

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Russo, Giuliano; Ferrinho, Paulo; de Sousa, Bruno; Conceição, Cláudia

2012-07-02

The debate over physicians' geographical distribution has attracted the attention of the economic and public health literature over the last forty years. Nonetheless, it is still to date unclear what influences physicians' location, and whether foreign physicians contribute to fill the geographical gaps left by national doctors in any given country. The present research sets out to investigate the current distribution of national and international physicians in Portugal, with the objective to understand its determinants and provide an evidence base for policy-makers to identify policies to influence it. A cross-sectional study of physicians currently registered in Portugal was conducted to describe the population and explore the association of physician residence patterns with relevant personal and municipality characteristics. Data from the Portuguese Medical Council on physicians' residence and characteristics were analysed, as well as data from the National Institute of Statistics on municipalities' population, living standards and health care network. Descriptive statistics, chi-square tests, negative binomial and logistic regression modelling were applied to determine: (a) municipality characteristics predicting Portuguese and International physicians' geographical distribution, and; (b) doctors' characteristics that could increase the odds of residing outside the country's metropolitan areas. There were 39,473 physicians in Portugal in 2008, 51.1% of whom male, and 40.2% between 41 and 55 years of age. They were predominantly Portuguese (90.5%), with Spanish, Brazilian and African nationalities also represented. Population, Population's Purchasing Power, Nurses per capita and Municipality Development Index (MDI) were the municipality characteristics displaying the strongest association with national physicians' location. For foreign physicians, the MDI was not statistically significant, while municipalities' foreign population applying for residence

What influences national and foreign physicians’ geographic distribution? An analysis of medical doctors’ residence location in Portugal

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Russo Giuliano

2012-07-01

Full Text Available Abstract Background The debate over physicians’ geographical distribution has attracted the attention of the economic and public health literature over the last forty years. Nonetheless, it is still to date unclear what influences physicians’ location, and whether foreign physicians contribute to fill the geographical gaps left by national doctors in any given country. The present research sets out to investigate the current distribution of national and international physicians in Portugal, with the objective to understand its determinants and provide an evidence base for policy-makers to identify policies to influence it. Methods A cross-sectional study of physicians currently registered in Portugal was conducted to describe the population and explore the association of physician residence patterns with relevant personal and municipality characteristics. Data from the Portuguese Medical Council on physicians’ residence and characteristics were analysed, as well as data from the National Institute of Statistics on municipalities’ population, living standards and health care network. Descriptive statistics, chi-square tests, negative binomial and logistic regression modelling were applied to determine: (a municipality characteristics predicting Portuguese and International physicians’ geographical distribution, and; (b doctors’ characteristics that could increase the odds of residing outside the country’s metropolitan areas. Results There were 39,473 physicians in Portugal in 2008, 51.1% of whom male, and 40.2% between 41 and 55 years of age. They were predominantly Portuguese (90.5%, with Spanish, Brazilian and African nationalities also represented. Population, Population’s Purchasing Power, Nurses per capita and Municipality Development Index (MDI were the municipality characteristics displaying the strongest association with national physicians’ location. For foreign physicians, the MDI was not statistically significant

Communication skills curriculum for foreign medical graduates in an internal medicine residency program.

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Ramaswamy, Ravishankar; Williams, Alicia; Clark, Elizabeth M; Kelley, Amy S

2014-11-01

Effective communication is an important aspect of caring for the elderly, who are more likely to have multimorbidity, limited health literacy, and psychosocial barriers to care. About half of Internal Medicine (IM) trainees in the United States are foreign medical graduates, and may not have been exposed to prior communication skills education. This novel communication skills curriculum for IM interns aimed to increase trainees' confidence and use of specific communication tools with older adults, particularly in delivering bad news and conducting family meetings. The workshop consisted of two interactive sessions in a small group with two learners and one or two facilitators, during the 4-week geriatrics block in IM internship training year. Twenty-three IM interns at an urban Veterans Affairs Medical Center were surveyed at the beginning and at the end of the 4-week block and 3 months after completion of the workshop about their knowledge, confidence, and skill in communication and asked about challenges to effective communication with older adults. The primary outcome measure was change in self-reported confidence and behavior in communication at 4 weeks. On a 4-point Likert scale, there was average improvement of 0.70 in self-reported confidence in communication, which was sustained 3 months after completion of the workshop. Participants reported several patient, physician, and system barriers to effective communication. Communication skills education in a small-group setting and the opportunity for repeated practice and self-reflection resulted in a sustained increase in overall confidence in IM interns in communication with older adults and may help overcome certain patient- and physician-specific communication barriers. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

Hand hygiene of medical students and resident physicians: predictors of attitudes and behaviour.

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Barroso, Violeta; Caceres, Wendy; Loftus, Pooja; Evans, Kambria H; Shieh, Lisa

2016-09-01

We measured medical students' and resident trainees' hand hygiene behaviour, knowledge and attitudes in order to identify important predictors of hand hygiene behaviour in this population. An anonymous, web-based questionnaire was distributed to medical students and residents at Stanford University School of Medicine in August of 2012. The questionnaire included questions regarding participants' behaviour, knowledge, attitude and experiences about hand hygiene. Behaviour, knowledge and attitude indices were scaled from 0 to 1, with 1 representing superior responses. Using multivariate regression, we identified positive and negative predictors of superior hand hygiene behaviour. We investigated effectiveness of interventions, barriers and comfort reminding others. 280 participants (111 students and 169 residents) completed the questionnaire (response rate 27.8%). Residents and medical students reported hand hygiene behaviour compliance of 0.45 and 0.55, respectively (p=0.02). Resident and medical student knowledge was 0.80 and 0.73, respectively (p=0.001). The attitude index for residents was 0.56 and 0.55 for medical students. Regression analysis identified experiences as predictors of hand hygiene behaviour (both positive and negative influence). Knowledge was not a significant predictor of behaviour, but a working gel dispenser and observing attending physicians with good hand hygiene practices were reported by both groups as the most effective strategy in influencing trainees. Medical students and residents have similar attitudes about hand hygiene, but differ in their level of knowledge and compliance. Concerns about hierarchy may have a significant negative impact on hand hygiene advocacy. 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/

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

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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

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.

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

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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.

The contribution of work characteristics, home characteristics and gender to burnout in medical residents.

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Verweij, Hanne; van der Heijden, Frank M M A; van Hooff, Madelon L M; Prins, Jelle T; Lagro-Janssen, Antoine L M; van Ravesteijn, Hiske; Speckens, Anne E M

2017-10-01

Burnout is highly prevalent in medical residents. In order to prevent or reduce burnout in medical residents, we should gain a better understanding of contributing and protective factors of burnout. Therefore we examined the associations of job demands and resources, home demands and resources, and work-home interferences with burnout in male and female medical residents. This study was conducted on a nation-wide sample of medical residents. In 2005, all Dutch medical residents (n = 5245) received a self-report questionnaire on burnout, job and home demands and resources and work-home interference. Path analysis was used to examine the associations between job and home characteristics and work-home interference and burnout in both males and females. In total, 2115 (41.1 %) residents completed the questionnaire. In both sexes emotional demands at work and the interference between work and home were important contributors to burnout, especially when work interferes with home life. Opportunities for job development appeared to be an important protective factor. Other contributing and protective factors were different for male and female residents. In females, social support from family or partner seemed protective against burnout. In males, social support from colleagues and participation in decision-making at work seemed important. Effectively handling emotional demands at work, dealing with the interference between work and home, and having opportunities for job development are the most essential factors which should be addressed. However it is important to take gender differences into consideration when implementing preventive or therapeutic interventions for burnout in medical residents.

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

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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

Shortening the Miles to the Milestones: Connecting EPA-Based Evaluations to ACGME Milestone Reports for Internal Medicine Residency Programs.

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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.

ASSOCIATION BETWEEN BURNOUT SYNDROME IN INTERNAL MEDICINE RESIDENTS, THEIR REPORT OF THE SUBOPTIMAL CARE PRACTICES AND PATIENTS’ REPORT

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ISABEL CASTAÑO

2006-10-01

Full Text Available This investigation pretended to establish the association between the Burnout Syndrome in internal medicine residents,the report of their sub optimal medical practices and the report of their hospitalized patients in charge, by using amultitrait-multimethod with a concurrent design that allows the research of two objects in the same investigation withconvergent results. The translated version by Moreno (2004 of the Maslach Burnout Inventory (MBI and the semistructured interview were used in medical residents, and a questionnaire to patients based on the scales proposed byMcKinley, Manku-Scott, Hastings, French and Baker (1997 in their research. The results showed no associationbetween the Burnout Syndrome and the report of the sub optimal practices from residents and patients. On thecontrary, it was found a significant association between the communication category and the report of patients. Finally,suggestions are formulated for improvements of these sub optimal practices and complementary studiesare proposed.

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

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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.

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

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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

Medical student views on the use of Facebook profile screening by residency admissions committees.

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George, Daniel R; Green, Michael J; Navarro, Anita M; Stazyk, Kelly K; Clark, Melissa A

2014-05-01

Previous research has shown that >50% of residency programmes indicate that inappropriate Facebook postings could be grounds for rejecting a student applicant. This study sought to understand medical students' views regarding the impact of their Facebook postings on the residency admissions process. In 2011-2012, we conducted a national survey of 7144 randomly selected medical students representing 10% of current enrollees in US medical schools. Students were presented with a hypothetical scenario of a residency admissions committee searching Facebook and finding inappropriate pictures of a student, and were asked how the committee ought to regard these pictures. The response rate was 30% (2109/7144). Respondents did not differ from medical students nationally with regard to type of medical school and regional representation. Of the three options provided, the majority of respondents (63.5%) indicated 'the pictures should be considered along with other factors, but should not be grounds for automatic rejection of the application'. A third (33.7%) believed 'the pictures should have no bearing on my application; the pictures are irrelevant'. A small minority of respondents (2.8%) felt 'the pictures should be grounds for automatic rejection of the application'. That the views of students regarding the consequences of their online activity differ so greatly from the views of residency admissions committees speaks to the need for better communication between these parties. It also presents opportunities for medical schools to help students in their residency application process by increasing awareness of social media screening strategies used by some residency programmes, and fostering self-awareness around the use of social media during medical school and especially during the residency application process.

Association of medical student burnout with residency specialty choice.

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Enoch, Lindsey; Chibnall, John T; Schindler, Debra L; Slavin, Stuart J

2013-02-01

Given the trend among medical students away from primary care medicine and toward specialties that allow for more controllable lifestyles, the identification of factors associated with specialty choice is important. Burnout is one such factor. The purpose of this study was to examine the associations between burnout and residency specialty choice in terms of provision for a less versus more controllable lifestyle (e.g. internal medicine versus dermatology) and a lower versus higher income (e.g. paediatrics versus anaesthesiology). A survey was sent to 165 Year 4 medical students who had entered the residency matching system. Students answered questions about specialty choice, motivating factors (lifestyle, patient care and prestige) and perceptions of medicine as a profession. They completed the Maslach Burnout Inventory-Human Services (MBI), which defines burnout in relation to emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA). Burnout and other variables were tested for associations with specialty lifestyle controllability and income. A response rate of 88% (n = 145) was achieved. Experiences of MBI-EE, MBI-DP and MBI-PA burnout were reported by 42 (29%), 26 (18%) and 30 (21%) students, respectively. Specialties with less controllable lifestyles were chosen by 87 (60%) students and lower-income specialties by 81 (56%). Adjusted odds ratios (ORs) indicated that the choice of a specialty with a more controllable lifestyle was associated with higher MBI-EE burnout (OR = 1.77, 95% confidence interval [CI] 1.06-2.96), as well as stronger lifestyle- and prestige-related motivation, and weaker patient care-related motivation. The choice of a higher-income specialty was associated with lower MBI-PA burnout (OR = 0.56, 95% CI 0.32-0.98), weaker lifestyle- and patient care-related motivation, and stronger prestige-related motivation. Specialty choices regarding lifestyle controllability and income were associated with the amount and type of

Initial Characterization of Internal Medicine Resident Resilience and Association with Stress and Burnout

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Amber-Nicole Bird

2016-01-01

Full Text Available Introduction. Burnout is prevalent in medical trainees. Little data exists on resident resilience. Methods. Anonymous surveys were provided to a convenience sample of internal medicine residents. Resilience was assessed using the Connor-Davidson resilience scale. Responses were categorized into low (<70, intermediate (70–79, and high (80–100 resilience. Results. 77 residents from six institutions completed surveys. 26% of residents had high resilience, 43% intermediate, and 31% low. The mean resilience score was 73.6±9.6 and lower than the general population (mean 80.4±12.5, p<0.001. Trainees with high resilience were more likely to never have stress interfere with their relationships outside of work (high: 40%; low: 0%; p<0.001. High resilience residents were more likely to have the skills to manage stress and burnout (high: 80%; low: 46%; p=0.02 and less likely to feel inferior to peers (high: 20.0%; low: 70.8%; p<0.001. There was a trend towards those with high resilience reporting less burnout (high: 40.0%; intermediate: 27%; low: 16.7%; p=0.08. Only 60% report a program outlet to discuss burnout. Conclusions. There is a wide range of resilience among IM residents and scores were lower than the general population. Low resilience is associated with more stress interfering with relationships, feeling inferior to peers, and fewer skills to manage stress and burnout.

Residents' Ratings of Their Clinical Supervision and Their Self-Reported Medical Errors: Analysis of Data From 2009.

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Baldwin, DeWitt C; Daugherty, Steven R; Ryan, Patrick M; Yaghmour, Nicholas A; Philibert, Ingrid

2018-04-01

Medical errors and patient safety are major concerns for the medical and medical education communities. Improving clinical supervision for residents is important in avoiding errors, yet little is known about how residents perceive the adequacy of their supervision and how this relates to medical errors and other education outcomes, such as learning and satisfaction. We analyzed data from a 2009 survey of residents in 4 large specialties regarding the adequacy and quality of supervision they receive as well as associations with self-reported data on medical errors and residents' perceptions of their learning environment. Residents' reports of working without adequate supervision were lower than data from a 1999 survey for all 4 specialties, and residents were least likely to rate "lack of supervision" as a problem. While few residents reported that they received inadequate supervision, problems with supervision were negatively correlated with sufficient time for clinical activities, overall ratings of the residency experience, and attending physicians as a source of learning. Problems with supervision were positively correlated with resident reports that they had made a significant medical error, had been belittled or humiliated, or had observed others falsifying medical records. Although working without supervision was not a pervasive problem in 2009, when it happened, it appeared to have negative consequences. The association between inadequate supervision and medical errors is of particular concern.

Use of simulation-based education to improve resident learning and patient care in the medical intensive care unit: a randomized trial.

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Schroedl, Clara J; Corbridge, Thomas C; Cohen, Elaine R; Fakhran, Sherene S; Schimmel, Daniel; McGaghie, William C; Wayne, Diane B

2012-04-01

The purpose of this study is to determine the effect of simulation-based education on the knowledge and skills of internal medicine residents in the medical intensive care unit (MICU). From January 2009 to January 2010, 60 first-year residents at a tertiary care teaching hospital were randomized by month of rotation to an intervention group (simulator-trained, n = 26) and a control group (traditionally trained, n = 34). Simulator-trained residents completed 4 hours of simulation-based education before their medical intensive care unit (MICU) rotation. Topics included circulatory shock, respiratory failure, and mechanical ventilation. After their rotation, residents completed a standardized bedside skills assessment using a 14-item checklist regarding respiratory mechanics, ventilator settings, and circulatory parameters. Performance of simulator-trained and traditionally trained residents was compared using a 2-tailed independent-samples t test. Simulator-trained residents scored significantly higher on the bedside skills assessment compared with traditionally trained residents (82.5% ± 10.6% vs 74.8% ± 14.1%, P = .027). Simulator-trained residents were highly satisfied with the simulation curriculum. Simulation-based education significantly improved resident knowledge and skill in the MICU. Knowledge acquired in the simulated environment was transferred to improved bedside skills caring for MICU patients. Simulation-based education is a valuable adjunct to standard clinical training for residents in the MICU. Copyright © 2012 Elsevier Inc. All rights reserved.

Mentoring during Medical School and Match Outcome among Emergency Medicine Residents.

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Dehon, Erin; Cruse, Margaret H; Dawson, Brandon; Jackson-Williams, Loretta

2015-11-01

Few studies have documented the value of mentoring for medical students, and research has been limited to more subjective (e.g., job satisfaction, perceived career preparation) rather than objective outcomes. This study examined whether having a mentor is associated with match outcome (where a student matched based on their rank order list [ROL]). We sent a survey link to all emergency medicine (EM) program coordinators to distribute to their residents. EM residents were surveyed about whether they had a mentor during medical school. Match outcome was assessed by asking residents where they matched on their ROL (e.g., first choice, fifth choice). They were also asked about rank in medical school, type of degree (MD vs. DO), and performance on standardized tests. Residents who indicated having a mentor completed the Mentorship Effectiveness Scale (MES), which evaluates behavioral characteristics of the mentor and yields a total score. We assessed correlations among these variables using Pearson's correlation coefficient. Post-hoc analysis using independent sample t-test was conducted to compare differences in the MES score between those who matched to their first or second choice vs. third or higher choice. Participants were a convenience sample of 297 EM residents. Of those, 199 (67%) reported having a mentor during medical school. Contrary to our hypothesis, there was no significant correlation between having a mentor and match outcome (r=0.06, p=0.29). Match outcome was associated with class rank (r=0.13, p=0.03), satisfaction with match outcome (r= -0.37, pmentors, a t-test revealed that the MES score was significantly higher among those who matched to their first or second choice (M=51.31, SD=10.13) compared to those who matched to their third or higher choice (M=43.59, SD=17.12), t(194)=3.65, pmentor during medical school does not impact match outcome, but having an effective mentor is associated with a more favorable match outcome among medical students

Main Educational Stressors and theirs Relationship with General Health of Medical Residents

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Nahid Khajehmougahi

2009-03-01

Full Text Available Background: In the age of information and technology application, troublesome regulations and traditional  procedures for medical education may cause serious stresses and be a threat to the general health (GH of the students of medicine.Purpose: To determine the relationship between educational stressors and the general health of residents studying at the Ahwaz Jundishapour  University of Medical Sciences (Alums.Method: In this cross sectional study, the study group was consisted  of  ll4 cooperative residents (69% of all residents in the hospital, who were being trained in a variety of different specialties.  The instruments used were the Educational Stressors Questionnaire, including 45 four-choice items and a General  Health Questionnaire. When the questionnaires were completed, the results were analyzed through Pierson Correlation Coefficient using the SPSS.Results: The residents mentioned their educational stressors as follows: lack of an arranged curriculum, troublesome educational regulations, deficient educational instruments, and inadequate clinical instruction. of all the subjects, 43 ( 37.6% appeared to have problems in GH,and significantly positive correlation (pmedical instructional techniques.Keywords: educational stressor, general health, medical residents, medical  education

Frequency of Burnout, Sleepiness and Depression in Emergency Medicine Residents with Medical Errors in the Emergency Department

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Alireza Aala

2014-07-01

Full Text Available Aims: Medical error is a great concern of the patients and physicians. It usually occurs due to physicians’ exhaustion, distress and fatigue. In this study, we aimed to evaluate frequency of distress and fatigue among emergency medicine residents reporting a medical error. Materials and Methods: The study population consisted of emergency medicine residents who completed an emailed questionnaire including self-assessment of medical errors, the Epworth Sleepiness Scale (ESS score, the Maslach Burnout Inventory, and PRIME-MD validated depression screening tool.   Results: In this survey, 100 medical errors were reported including diagnostic errors in 53, therapeutic errors in 24 and following errors in 23 subjects. Most errors were reported by males and third year residents. Residents had no signs of depression, but all had some degrees of sleepiness and burnout. There were significant differences between errors subtypes and age, residency year, depression, sleepiness and burnout scores (p<0.0001.   Conclusion: In conclusion, residents committing a medical error usually experience burnout and have some grades of sleepiness that makes them less motivated increasing the probability of medical errors. However, as none of the residents had depression, it could be concluded that depression has no significant role in medical error occurrence and perhaps it is a possible consequence of medical error.    Keywords: Residents; Medical error; Burnout; Sleepiness; Depression

Moving beyond the language barrier: the communication strategies used by international medical graduates in intercultural medical encounters.

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Jain, Parul; Krieger, Janice L

2011-07-01

To understand the communication strategies international medical graduates use in medical interactions to overcome language and cultural barriers. In-depth interviews were conducted with 12 international physicians completing their residency training in internal medicine in a large hospital in Midwestern Ohio. The interview explored (a) barriers participants encountered while communicating with their patients regarding language, affect, and culture, and (b) communication convergence strategies used to make the interaction meaningful. International physicians use multiple convergence strategies when interacting with their patients to account for the intercultural and intergroup differences, including repeating information, changing speaking styles, and using non-verbal communication. Understanding barriers to communication faced by international physicians and recognizing accommodation strategies they employ in the interaction could help in training of future international doctors who come to the U.S. to practice medicine. Early intervention could reduce the time international physicians spend navigating through the system and trying to learn by experimenting with different strategies which will allow these physicians to devote more time to patient care. We recommend developing a training manual that is instructive of the socio-cultural practices of the region where international physician will start practicing medicine. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Learning styles of medical students, general surgery residents, and general surgeons: implications for surgical education.

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Engels, Paul T; de Gara, Chris

2010-06-30

Surgical education is evolving under the dual pressures of an enlarging body of knowledge required during residency and mounting work-hour restrictions. Changes in surgical residency training need to be based on available educational models and research to ensure successful training of surgeons. Experiential learning theory, developed by David Kolb, demonstrates the importance of individual learning styles in improving learning. This study helps elucidate the way in which medical students, surgical residents, and surgical faculty learn. The Kolb Learning Style Inventory, which divides individual learning styles into Accommodating, Diverging, Converging, and Assimilating categories, was administered to the second year undergraduate medical students, general surgery resident body, and general surgery faculty at the University of Alberta. A total of 241 faculty, residents, and students were surveyed with an overall response rate of 73%. The predominant learning style of the medical students was assimilating and this was statistically significant (p learning style found in the residents and faculty. The predominant learning styles of the residents and faculty were convergent and accommodative, with no statistically significant differences between the residents and the faculty. We conclude that medical students have a significantly different learning style from general surgical trainees and general surgeons. This has important implications in the education of general surgery residents.

The electronic residency application service application can predict accreditation council for graduate medical education competency-based surgical resident performance.

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Tolan, Amy M; Kaji, Amy H; Quach, Chi; Hines, O Joe; de Virgilio, Christian

2010-01-01

Program directors often struggle to determine which factors in the Electronic Residency Application Service (ERAS) application are important in the residency selection process. With the establishment of the Accreditation Council for Graduate Medical Education (ACGME) competencies, it would be important to know whether information available in the ERAS application can predict subsequent competency-based performance of general surgery residents. This study is a retrospective correlation of data points found in the ERAS application with core competency-based clinical rotation evaluations. ACGME competency-based evaluations as well as technical skills assessment from all rotations during residency were collected. The overall competency score was defined as an average of all 6 competencies and technical skills. A total of77 residents from two (one university and one community based university-affiliate) general surgery residency programs were included in the analysis. Receiving honors for many of the third year clerkships and AOA membership were associated with a number of the individual competencies. USMLE scores were predictive only of Medical Knowledge (p = 0.004). Factors associated with higher overall competency were female gender (p = 0.02), AOA (p = 0.06), overall number of honors received (p = 0.04), and honors in Ob/Gyn (p = 0.03) and Pediatrics (p = 0.05). Multivariable analysis showed honors in Ob/Gyn, female gender, older age, and total number of honors to be predictive of a number of individual core competencies. USMLE scores were only predictive of Medical Knowledge. The ERAS application is useful for predicting subsequent competency based performance in surgical residents. Receiving honors in the surgery clerkship, which has traditionally carried weight when evaluating a potential surgery resident, may not be as strong a predictor of future success. Copyright © 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights

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

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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.

Determinants of Medical and Health Care Expenditure Growth for Urban Residents in China: A Systematic Review Article.

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Zhu, Xiaolong; Cai, Qiong; Wang, Jin; Liu, Yun

2014-12-01

In recent years, medical and health care consumption has risen, making health risk an important determinant of household spending and welfare. We aimed to examine the determinants of medical and health care expenditure to help policy-makers in the improvement of China's health care system, benefiting the country, society and every household. This paper employs panel data from China's provinces from 2001 to 2011 with all possible economic variations and studies the determinants of medical and healthcare expenditure for urban residents. CPI (consumer price index) of medical services and the resident consumption level of urban residents have positive influence on medical and health care expenditures for urban residents, while the local medical budget, the number of health institutions, the incidence of infectious diseases, the year-end population and the savings of urban residents will not have effect on medical and health care expenditure for urban residents. This paper proposed three relevant policy suggestions for Chinese governments based on the findings of the research.

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

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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.

Differences between medical student and faculty perceptions of the competencies needed for the first year of residency.

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Fürstenberg, Sophie; Harendza, Sigrid

2017-11-09

Different guidelines and frameworks like the CanMEDs model or entrustable professional activities (EPAs) describe competencies required for successful and professional work of residents. Not all competencies are of equal importance for graduates when they start their residency. The aim of this study was to evaluate the relevance of different competencies for a first year resident from the perspective of physicians and medical students. In an online study, 178 of 475 surgeons and internists including residents and attendings and 102 of 728 first and last year undergraduate medical students from the University Medical Center Hamburg-Eppendorf ranked 25 competencies according to their relevance for entrustment decisions in first year residents. The rankings of the competencies by residents and attendings and by first year and last year medical student were compared. Additionally, the rankings were also compared to the literature. Physicians and medical students rated 'Responsibility' as the most important competency for first year residents. Physicians ranked 'Teamwork and collegiality' and 'Structure, work planning and priorities' within the top 10 competencies significantly higher than medical students. The competency ranks between attendings and residents only showed one significant difference between attendings and residents, where 'Coping with mistakes', was ranked significantly higher by residents. Medical students ranked 'Active listening to patients', 'Advising patients' and 'Handling emotions of patients and their relatives' significantly higher than physicians. Final year students ranked 'Structure, work planning and priorities', 'Coping with mistakes', and 'Verbal communication with colleagues and supervisors' significantly higher than first year students. Even though physicians and medical students agree that 'Responsibility' is the most important competency for entrustment decisions in the first year of residency, medical students rate competencies

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

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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

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

[Depression, anxiety and suicide risk symptoms among medical residents over an academic year].

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Jiménez-López, José Luis; Arenas-Osuna, Jesús; Angeles-Garay, Ulises

2015-01-01

One of the causes of dissatisfaction among residents is related to burnout syndrome, stress and depression. The aim of this study is to describe the prevalence of depression, anxiety and suicide risk symptoms and its correlation with mental disorders among medical residents over an academic year. 108 medical residents registered to second year of medical residence answered the Beck Depression Inventory, the State-Trait Anxiety Inventory and the Suicide Risk Scale of Plutchik: at the entry, six months later and at the end of the academic year. Residents reported low depressive symptoms (3.7 %), low anxiety symptoms (38 %) and 1.9 % of suicide risk at the beginning of the academic year, which increased in second measurement to 22.2 % for depression, 56.5 % for anxiety and 7.4 % for suicide risk. The statistical analysis showed significant differences between the three measurements (p depressive disorder was 4.6 % and no anxiety disorder was diagnosed. Almost all of the residents with depressive disorder had personal history of depression. None reported the work or academic environment as a trigger of the disorder. There was no association by specialty, sex or civil status. The residents that are susceptible to depression must be detected in order to receive timely attention if they develop depressive disorder.

Description of a developmental criterion-referenced assessment for promoting competence in internal medicine residents.

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Varney, Andrew; Todd, Christine; Hingle, Susan; Clark, Michael

2009-09-01

End-of- rotation global evaluations can be subjective, produce inflated grades, lack interrater reliability, and offer information that lacks value. This article outlines the generation of a unique developmental criterion-referenced assessment that applies adult learning theory and the learner, manager, teacher model, and represents an innovative application to the American Board of Internal Medicine (ABIM) 9-point scale. We describe the process used by Southern Illinois University School of Medicine to develop rotation-specific, criterion-based evaluation anchors that evolved into an effective faculty development exercise. The intervention gave faculty a clearer understanding of the 6 Accreditation Council for Graduate Medical Education competencies, each rotation's educational goals, and how rotation design affects meaningful work-based assessment. We also describe easily attainable successes in evaluation design and pitfalls that other institutions may be able to avoid. Shifting the evaluation emphasis on the residents' development of competence has made the expectations of rotation faculty more transparent, has facilitated conversations between program director and residents, and has improved the specificity of the tool for feedback. Our findings showed the new approach reduced grade inflation compared with the ABIM end-of-rotation global evaluation form. We offer the new developmental criterion-referenced assessment as a unique application of the competences to the ABIM 9-point scale as a transferable model for improving the validity and reliability of resident evaluations across graduate medical education programs.

A Survey of Clinical Skills Evaluation Practices in Internal Medicine Residency Programs.

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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)

A narrative review on burnout experienced by medical students and residents.

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Dyrbye, Liselotte; Shanafelt, Tait

2016-01-01

To summarise articles reporting on burnout among medical students and residents (trainees) in a narrative review. MEDLINE was searched for peer-reviewed, English language articles published between 1990 and 2015 reporting on burnout among trainees. The search used combinations of Medical Subject Heading terms medical student, resident, internship and residency, and burnout, professional. Reference lists of articles were reviewed to identify additional studies. A subset of high-quality studies was selected. Studies suggest a high prevalence of burnout among trainees, with levels higher than in the general population. Burnout can undermine trainees' professional development, place patients at risk, and contribute to a variety of personal consequences, including suicidal ideation. Factors within the learning and work environment, rather than individual attributes, are the major drivers of burnout. Limited data are available regarding how to best address trainee burnout, but multi-pronged efforts, with attention to culture, the learning and work environment and individual behaviours, are needed to promote trainees' wellness and to help those in distress. Medical training is a stressful time. Large, prospective studies are needed to identify cause-effect relationships and the best approaches for improving the trainee experience. © 2015 John Wiley & Sons Ltd.

'It depends': medical residents' perspectives on working with nurses.

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Weinberg, Dana B; Miner, Dianne Cooney; Rivlin, Leetal

2009-07-01

Using the theory of relational coordination, which holds that in high-pressure settings such as hospitals, high-quality communication and strong relationships are necessary for coordinated action, we sought to determine the quality of the nurse-physician relationship by examining the communication and interaction between nurses and residents from the residents' perspective. A sample of 20 medical and surgical residents, selected by a snowball sampling technique, were interviewed about the quality of their communication and relationships with nurses in the workplace. Residents' responses were influenced by their perceptions of nurses' cooperativeness and competence, and their impressions of nurses' professional preparation and demeanor varied widely. Although 19 of 20 residents reported instances of poor communication or problematic relationships with nurses, most believed that this posed no significant threat to patient care because the nurses' role, as they saw it, was one of simply following orders. Given the strong doubts some residents expressed about nurses' cooperativeness and competence, the nursing profession should consider strengthening nursing education and clearly delineating nurses' roles and competencies.

The "Near-Peer" Approach to Teaching Musculoskeletal Physical Examination Skills Benefits Residents and Medical Students.

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Rosenberg, Casandra J; Nanos, Katherine N; Newcomer, Karen L

2017-03-01

The musculoskeletal physical examination (MSK PE) is an essential part of medical student training, and it is best taught in a hands-on, longitudinal fashion. A barrier to this approach is faculty instructor availability. "Near-peer" teaching refers to physicians-in-training teaching their junior colleagues. It is unknown whether near-peer teaching is effective in teaching this important physical examination skill. To investigate attitudes of medical students and physical medicine and rehabilitation (PM&R) residents regarding near-peer teaching in an MSK PE curriculum. Qualitative, anonymous paper and online surveys. Tertiary academic center with a medical school and PM&R training program. Ninety-nine second- and third-year medical students and 13 PM&R residents in their third or fourth postgraduate year. Attitudes of second- and third-year medical students were measured immediately after their MSK PE course. Resident attitudes were measured in a single cross-sectional sample. Student attitudes were assessed via a questionnaire with 5-point Likert scales and a free-text comment section. The resident questionnaire included a combination of multiple-choice questions, rankings, free-text responses, and Likert scales. All 99 students completed the questionnaire. The majority of students (n = 79 [80%]) reported that resident involvement as hands-on instructors of examination skills was "very useful," and 87 (88%) indicated that resident-led small discussion groups were "very helpful" or "somewhat helpful." Fifty-seven of 99 students (58%) reported that the resident-facilitated course was "much better" than courses without resident involvement. Twelve of 13 eligible residents completed the survey, and of those, 8 found teaching "very helpful" to their MSK knowledge, and 11 became "somewhat" or "much more confident" in clinical examination skills. Our study supports educational benefits to medical students and resident instructors in our MSK PE program. We recommend

Identification and management of chronic kidney disease complications by internal medicine residents: a national survey.

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Agrawal, Varun; Agarwal, Mohit; Ghosh, Amit K; Barnes, Michael A; McCullough, Peter A

2011-05-01

Many patients with chronic kidney disease (CKD) receive care from primary care physicians. Identification and management of CKD complications in primary care is suboptimal. It is not known if current residency curriculum adequately prepares a future internist in this aspect of CKD care. We performed an online questionnaire survey of internal medicine residents in the United States to determine knowledge of CKD complications and their management. Four hundred seventy-nine residents completed the survey with postgraduate year (PGY) distribution 166 PGY1, 187 PGY2, and 126 PGY3. Most of the residents correctly recognized anemia (91%) and bone disease (82%) as complications at estimated glomerular filtration rate less than 60 mL/min/1.73 m; however, only half of the residents identified coronary artery disease (54%) as a CKD complication. For a patient with estimated glomerular filtration rate less than 60 mL/min/1.73 m, two thirds of the residents would workup for anemia (62%), whereas half of them would check for mineral and bone disorder (56%). With regard to anemia of CKD, less than half of the residents knew the CKD goal hemoglobin level of 11 to 12 g/dL (44%); most would supplement iron stores (86%), whereas fewer would consider nephrology referral (28%). For mineral and bone disorders, many residents would recommend dietary phosphorus restriction (68%) and check 25-hydroxyvitamin D (62%); fewer residents would start 1,25-dihydroxyvitamin D (40%) or refer to the nephrologist (45%). Residents chose to discontinue angiotensin-converting enzyme inhibitor for medication-related complication of greater than 50% decline in estimated glomerular filtration rate (68%) and potassium greater than 5.5 mEq/L (93%). Mean performance score improved with increasing PGY (PGY1 59.4% ± 17.6%, PGY2 63.6% ± 15.6%, and PGY3 66.2% ± 16.5%; P = 0.002). Our study identified specific gaps in knowledge of CKD complications and management among internal medicine residents. Educational

Attitudes of Portuguese medical residents' towards clinical communication skills.

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Loureiro, Elizabete; Severo, Milton; Ferreira, Maria Amélia

2015-08-01

To explore the attitudes and perceptions of Portuguese residents towards Clinical Communication Skills (CCS) and the need for complementary training. 78 medical residents responded to an on-line questionnaire which comprised demographic data, open-ended questions and a Portuguese version of the Communication Skills Attitude Scale (CSAS). Residents gave significantly higher scores (Pcommunication skills in general, compared to CSAS2 (attitudes towards the teaching/learning process of CCS). Residents doing their residency training in other parts of the country, other than the north, reveal a higher perception of insufficient training (72.7% vs. 38.7%, P=0.036). Residents showed more positive attitudes towards communication skills than towards the teaching/learning process. They admit to need more training in CCS in their residency year and highlight that the clinical cycle of undergraduate education should integrate these topics. Content analysis indicates that residents' perceptions are context-influenced. Integration of CCS in the undergraduate education, enhanced during post-graduate training. Training of clinical faculty and supervisors/tutors and the role that stakeholders have to play in order to promote continuous training in CCS; encourage patient-centeredness and reflective practice, as to facilitate transfer of acquired skills to clinical practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

An international basic science and clinical research summer program for medical students.

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Ramjiawan, Bram; Pierce, Grant N; Anindo, Mohammad Iffat Kabir; Alkukhun, Abedalrazaq; Alshammari, Abdullah; Chamsi, Ahmad Talal; Abousaleh, Mohannad; Alkhani, Anas; Ganguly, Pallab K

2012-03-01

An important part of training the next generation of physicians is ensuring that they are exposed to the integral role that research plays in improving medical treatment. However, medical students often do not have sufficient time to be trained to carry out any projects in biomedical and clinical research. Many medical students also fail to understand and grasp translational research as an important concept today. In addition, since medical training is often an international affair whereby a medical student/resident/fellow will likely train in many different countries during his/her early training years, it is important to provide a learning environment whereby a young medical student experiences the unique challenges and value of an international educational experience. This article describes a program that bridges the gap between the basic and clinical research concepts in a unique international educational experience. After completing two semester curricula at Alfaisal University in Riyadh, Kingdom of Saudi Arabia, six medical students undertook a summer program at St. Boniface Hospital Research Centre, in Winnipeg, MB, Canada. The program lasted for 2 mo and addressed advanced training in basic science research topics in medicine such as cell isolation, functional assessment, and molecular techniques of analysis and manipulation as well as sessions on the conduct of clinical research trials, ethics, and intellectual property management. Programs such as these are essential to provide a base from which medical students can decide if research is an attractive career choice for them during their clinical practice in subsequent years. An innovative international summer research course for medical students is necessary to cater to the needs of the medical students in the 21st century.

Middle Manager Role of the Chief Medical Resident: An Organizational Psychologist’s Perspective

OpenAIRE

Berg, David Nelson; Huot, Stephen Joseph

2007-01-01

The role of the chief resident in internal medicine is examined through the eyes of an organizational psychologist who, over a 3-year period, met with each of 6 groups of chief residents for an average of 1 hour a week over the 12 months of the job. Based on this experience, the chief resident job is conceptualized as a middle management role with 4 distinct types of tasks: up work, down work, lateral work, and internal work. Core challenges facing the chief residents at each stage of the chi...

How medical students learn from residents in the workplace: a qualitative study.

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Karani, Reena; Fromme, H Barrett; Cayea, Danelle; Muller, David; Schwartz, Alan; Harris, Ilene B

2014-03-01

To explore what third-year medical students learn from residents and which teaching strategies are used by excellent resident teachers in their interactions with students in the clinical workplace environment. In this multi-institutional qualitative study between January and March 2012, the authors conducted focus groups with medical students who were midway through their third year. Qualitative analysis was used to identify themes. Thirty-seven students participated. Students contributed 228 comments related to teaching methods used by residents. The authors categorized these into 20 themes within seven domains: role-modeling, focusing on teaching, creating a safe learning environment, providing experiential learning opportunities, giving feedback, setting expectations, and stimulating learning. Role-modeling, the most frequently classified method of teaching in this study, was not included in three popular "Resident-as-Teacher" (RAT) models. Strategies including offering opportunities for safe practice, involving students in the team, and providing experiential learning opportunities were not emphasized in these models either. Almost 200 comments representing the knowledge and skills students learned from residents were categorized into 33 themes within nine domains: patient care, communication, navigating the system, adaptability, functioning as a student/resident, lifelong learning, general comments, career/professional development, and medical content. Most of these areas are not emphasized in popular RAT models. Residents serve as critically important teachers of students in the clinical workplace. Current RAT models are based largely on the teaching behaviors of faculty. The content and teaching strategies identified by students in this study should serve as the foundation for future RAT program development.

Psychosocial and career outcomes of peer mentorship in medical resident education: a systematic review protocol.

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Pethrick, Helen; Nowell, Lorelli; Oddone Paolucci, Elizabeth; Lorenzetti, Liza; Jacobsen, Michele; Clancy, Tracey; Lorenzetti, Diane L

2017-08-31

Many medical residents lack ready access to social and emotional supports that enable them to successfully cope with the challenges associated with medical residency. This absence of support has been shown to lead to high levels of burnout, decreased mental wellbeing, and difficulty mastering professional competencies in this population. While there is emerging evidence that peer mentoring can be an important source of psychosocial and career-related support for many individuals, the extent of the evidence regarding the benefits of peer mentorship in medical residency education has not yet been established. We describe a protocol for a systematic review to assess the effects of peer mentoring on medical residents' mental wellbeing, social connectedness, and professional competencies. Studies included in this review will be those that report on peer-mentoring relationships among medical residents. Quantitative, qualitative, and mixed-methods studies will be eligible for inclusion. No date or language limits will be applied. We will search EMBASE, MEDLINE, PsychINFO, Web of Science, Scopus, ERIC, Education Research Complete, and Academic Research Complete databases to identify relevant studies. Two authors will independently assess all abstracts and full-text studies for inclusion and study quality and extract study data in duplicate. This is the first systematic review to explicitly explore the role of peer mentoring in the context of medical residency education. We anticipate that the findings from this review will raise awareness of the benefits and challenges associated with peer-mentoring relationships, further the development and implementation of formal peer-mentoring programs for medical residents, and, through identifying gaps in the existing literature, inform future research efforts. This protocol has not been registered in PROSPERO or any other publicly accessible registry.

Burnout, anxiety, depression, and social skills in medical residents.

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Pereira-Lima, K; Loureiro, S R

2015-01-01

The medical residency is recognized as a risk period for the development of burnout and mental health problems, such as anxiety and depression, which have impact on the physician and clientele alike. There is a need for studies that address conditions of risk and protection for the development of such problems. This study aimed to verify the rates of burnout, anxiety, and depression presented by resident physicians, as well as the associations of these problems with social skills, as potential protective factors. The hypothesis was defined that the problems (burnout, anxiety, and depression) would be negatively associated with social skills. A total of 305 medical residents, of both genders, of different specialties, from clinical and surgical areas of a Brazilian university hospital were evaluated using the following standardized self-report instruments: Burnout Syndrome Inventory, Social Skills Inventory, and the Patient Health Questionnaire-4. High rates of burnout and mental health problems were verified and social skills were negatively associated with burnout dimensions such as emotional exhaustion, emotional detachment, and dehumanization, but positively associated with personal accomplishment. Furthermore, residents with indicators of problems presented significantly lower social skills means than those of residents without indicators of burnout, anxiety, or depression. More studies are needed, which include other types of instruments in addition to self-report ones and evaluate not only social skills but also social competence in the professional practice. These should adopt intervention and longitudinal designs that allow the continuity or overcoming of the problems to be verified. Since social skills can be learned, the results of the study highlight the importance of developing the interpersonal skills of the professionals during the training of resident physicians in order to improve their practice.

Differences between medical student and faculty perceptions of the competencies needed for the first year of residency

Directory of Open Access Journals (Sweden)

Sophie Fürstenberg

2017-11-01

Full Text Available Abstract Background Different guidelines and frameworks like the CanMEDs model or entrustable professional activities (EPAs describe competencies required for successful and professional work of residents. Not all competencies are of equal importance for graduates when they start their residency. The aim of this study was to evaluate the relevance of different competencies for a first year resident from the perspective of physicians and medical students. Methods In an online study, 178 of 475 surgeons and internists including residents and attendings and 102 of 728 first and last year undergraduate medical students from the University Medical Center Hamburg-Eppendorf ranked 25 competencies according to their relevance for entrustment decisions in first year residents. The rankings of the competencies by residents and attendings and by first year and last year medical student were compared. Additionally, the rankings were also compared to the literature. Results Physicians and medical students rated ‘Responsibility’ as the most important competency for first year residents. Physicians ranked ‘Teamwork and collegiality’ and ‘Structure, work planning and priorities’ within the top 10 competencies significantly higher than medical students. The competency ranks between attendings and residents only showed one significant difference between attendings and residents, where ‘Coping with mistakes’, was ranked significantly higher by residents. Medical students ranked ‘Active listening to patients’, ‘Advising patients’ and ‘Handling emotions of patients and their relatives’ significantly higher than physicians. Final year students ranked ‘Structure, work planning and priorities’, ‘Coping with mistakes’, and ‘Verbal communication with colleagues and supervisors’ significantly higher than first year students. Conclusions Even though physicians and medical students agree that ‘Responsibility’ is the most important

Mentoring During Medical School and Match Outcome Among Emergency Medicine Residents

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Erin Dehon

2015-11-01

Full Text Available Introduction: Few studies have documented the value of mentoring for medical students, and research has been limited to more subjective (e.g., job satisfaction, perceived career preparation rather than objective outcomes. This study examined whether having a mentor is associated with match outcome (where a student matched based on their rank order list [ROL]. Methods: We sent a survey link to all emergency medicine (EM program coordinators to distribute to their residents. EM residents were surveyed about whether they had a mentor during medical school. Match outcome was assessed by asking residents where they matched on their ROL (e.g., first choice, fifth choice. They were also asked about rank in medical school, type of degree (MD vs. DO, and performance on standardized tests. Residents who indicated having a mentor completed the Mentorship Effectiveness Scale (MES, which evaluates behavioral characteristics of the mentor and yields a total score. We assessed correlations among these variables using Pearson’s correlation coefficient. Post-hoc analysis using independent sample t-test was conducted to compare differences in the MES score between those who matched to their first or second choice vs. third or higher choice. Results: Participants were a convenience sample of 297 EM residents. Of those, 199 (67% reported having a mentor during medical school. Contrary to our hypothesis, there was no significant correlation between having a mentor and match outcome (r=0.06, p=0.29. Match outcome was associated with class rank (r=0.13, p=0.03, satisfaction with match outcome (r= -0.37, p<0.001, and type of degree (r=0.12, p=0.04. Among those with mentors, a t-test revealed that the MES score was significantly higher among those who matched to their first or second choice (M=51.31, SD=10.13 compared to those who matched to their third or higher choice (M=43.59, SD=17.12, t(194=3.65, p<0.001, d=0.55. Conclusion: Simply having a mentor during medical

[Burnout syndrome in medical residents at the General Hospital of Durango, México].

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Terrones-Rodríguez, Jovany Francisco; Cisneros-Pérez, Vicente; Arreola-Rocha, José Jesús

2016-01-01

The burnout syndrome is commonly spread among health workers and students, due to the excessive demands they feel on their workspaces. Depersonalization, emotional exhaustion and personal accomplishment are the areas assessed. To determine the prevalence of burnout syndrome in medical residents at the General Hospital of Durango; a descriptive, prolective, cross-sectional study was designed and applied to residents of different specialties of the General Hospital of Durango who agreed to participate, the "Maslach Burnout Inventory" was applied. We surveyed 116 residents, 43.1 % (50) women and 56.89 % (66) men. The overall prevalence was 89.66 % (95 % CI: 82.63- 94.54). Affected in a single area the 48.28 % (95 % CI: 38.90-57.74), in two areas the 35.34 % (95 % CI: 26.69-44.76) and in the three areas 6.03 % (95 % CI: 2.46-12.04). Stratified by areas, high emotional exhaustion was 41.38 % (95 % CI: 32.31-50.90), high depersonalization in 54.31 % (95 % CI: 44.81-63.59), and low personal accomplishment 41.38 % (95 % CI: 32.31-50.90). The prevalence is higher than the reported. The most frequently affected is depersonalization, followed by emotional exhaustion and finally the personal accomplishment. In the areas of Gynecology and obstetrics, Internal medicine, Pediatrics and Orthopedics, the 100 % of the residents are affected.

Building bridges: engaging medical residents in quality improvement and medical leadership.

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Voogt, Judith J; van Rensen, Elizabeth L J; van der Schaaf, Marieke F; Noordegraaf, Mirko; Schneider, Margriet Me

2016-12-01

To develop an educational intervention that targets residents' beliefs and attitudes to quality Improvement (QI) and leadership in order to demonstrate proactive behaviour. Theory-driven, mixed methods study including document analysis, interviews, observations and open-ended questionnaires. Six Dutch teaching hospitals. Using expertise from medicine, psychology, organizational and educational sciences we developed a situated learning programme named Ponder and IMProve (PIMP). The acronym PIMP reflects the original upbeat name in Dutch, Verwonder & Verbeter. It has a modern, positive meaning that relates to improving your current circumstances. In quarterly 1-h sessions residents are challenged to identify daily workplace frustrations and translate them into small-scale QI activities. Organizational awareness, beliefs and attitudes to QI and organizational responsibilities, resident behaviour, barriers and facilitators to successful learning and the programme's potential impact on the organization. Overall, 19 PIMP meetings were held over a period of 3 years. Residents defined 119 PIMP goals, resolved 37 projects and are currently working on another 39 projects. Interviews show that PIMP sessions make residents more aware of the organizational aspects of their daily work. Moreover, residents feel empowered to take up the role of change agent. Facilitators for success include a positive cost-benefit trade-off, a valuable group process and a safe learning environment. This article demonstrates the added value of multidisciplinary theory-driven research for the design, development and evaluation of educational programmes. Residents can be encouraged to develop organizational awareness and reshape their daily frustrations in QI work. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Medical Residents' and Practicing Physicians' e-Cigarette Knowledge and Patient Screening Activities: Do They Differ?

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Geletko, Karen W; Myers, Karen; Brownstein, Naomi; Jameson, Breanna; Lopez, Daniel; Sharpe, Alaine; Bellamy, Gail R

2016-01-01

The purpose of this study was to compare medical residents and practicing physicians in primary care specialties regarding their knowledge and beliefs about electronic cigarettes (e-cigarettes). We wanted to ascertain whether years removed from medical school had an effect on screening practices, recommendations given to patients, and the types of informational sources utilized. A statewide sample of Florida primary care medical residents (n = 61) and practicing physicians (n = 53) completed either an online or paper survey, measuring patient screening and physician recommendations, beliefs, and knowledge related to e-cigarettes. χ 2 tests of association and linear and logistic regression models were used to assess the differences within- and between-participant groups. Practicing physicians were more likely than medical residents to believe e-cigarettes lower cancer risk in patients who use them as an alternative to cigarettes ( P = .0003). Medical residents were more likely to receive information about e-cigarettes from colleagues ( P = .0001). No statistically significant differences were observed related to e-cigarette knowledge or patient recommendations. Practicing primary care physicians are accepting both the benefits and costs associated with e-cigarettes, while medical residents in primary care are more reticent. Targeted education concerning the potential health risks and benefits associated with the use of e-cigarettes needs to be included in the current medical education curriculum and medical provider training to improve provider confidence in discussing issues surrounding the use of this product.

Learning styles of medical students, general surgery residents, and general surgeons: implications for surgical education

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de Gara Chris

2010-06-01

Full Text Available Abstract Background Surgical education is evolving under the dual pressures of an enlarging body of knowledge required during residency and mounting work-hour restrictions. Changes in surgical residency training need to be based on available educational models and research to ensure successful training of surgeons. Experiential learning theory, developed by David Kolb, demonstrates the importance of individual learning styles in improving learning. This study helps elucidate the way in which medical students, surgical residents, and surgical faculty learn. Methods The Kolb Learning Style Inventory, which divides individual learning styles into Accommodating, Diverging, Converging, and Assimilating categories, was administered to the second year undergraduate medical students, general surgery resident body, and general surgery faculty at the University of Alberta. Results A total of 241 faculty, residents, and students were surveyed with an overall response rate of 73%. The predominant learning style of the medical students was assimilating and this was statistically significant (p Conclusions We conclude that medical students have a significantly different learning style from general surgical trainees and general surgeons. This has important implications in the education of general surgery residents.

Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents.

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Martinez, William; Lehmann, Lisa Soleymani; Thomas, Eric J; Etchegaray, Jason M; Shelburne, Julia T; Hickson, Gerald B; Brady, Donald W; Schleyer, Anneliese M; Best, Jennifer A; May, Natalie B; Bell, Sigall K

2017-11-01

Open communication between healthcare professionals about care concerns, also known as 'speaking up', is essential to patient safety. Compare interns' and residents' experiences, attitudes and factors associated with speaking up about traditional versus professionalism-related safety threats. Anonymous, cross-sectional survey. Six US academic medical centres, 2013-2014. 1800 medical and surgical interns and residents (47% responded). Attitudes about, barriers and facilitators for, and self-reported experience with speaking up. Likelihood of speaking up and the potential for patient harm in two vignettes. Safety Attitude Questionnaire (SAQ) teamwork and safety scales; and Speaking Up Climate for Patient Safety (SUC-Safe) and Speaking Up Climate for Professionalism (SUC-Prof) scales. Respondents more commonly observed unprofessional behaviour (75%, 628/837) than traditional safety threats (49%, 410/837); pbarrier to speaking up about unprofessional behaviour compared with traditional safety threats (58%, 482/837 vs 42%, 348/837; psafety vignette, even when they perceived high potential patient harm (20%, 49/251 vs 71%, 179/251; psafety vignette (OR 1.90, 99% CI 1.36 to 2.66 and 1.46, 1.02 to 2.09, respectively), while only a positive perception of SUC-Prof was associated with speaking up in the professionalism vignette (1.76, 1.23 to 2.50). Interns and residents commonly observed unprofessional behaviour yet were less likely to speak up about it compared with traditional safety threats even when they perceived high potential patient harm. Measuring SUC-Safe, and particularly SUC-Prof, may fill an existing gap in safety culture assessment. 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/.

EKG analysis skills of family practice residents in the United Arab Emirates: a comparison with US data.

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Margolis, S; Reed, R

2001-06-01

Concern has been raised about the electrocardiogram (EKG) analysis skills of family practice residents in the United States. This study examined EKG analysis skills of family practice residents, medical students, interns, and general practitioners (GPs) in the United Arab Emirates (UAE), a different environment. The measurement instrument was a set of 10 EKGs, used in a study of US family practice residents. Two of the EKGs were normal, and there were 14 clinical abnormalities in the remainder. There was no significant difference in the correct diagnosis of acute myocardial infarction between US family practice residents and UAE family practice residents, medical students, or GPs. Interns' diagnoses were significantly poorer. The mean score for correctly identifying acute myocardial infarction and both normal EKGs was not significantly different between groups: 2.50 medical students, 2.35 interns, 2.58 UAE family practice residents, 2.67 FD, and 2.55 US family practice residents. However, the US family practice resident mean score of 11.26 for all 16 clinical findings was significantly higher than any group in the UAE: 5.35 medical students, 5.87 interns, 6.08 UAE family practice residents, 5.69 family physicians. Difficulty in EKG interpretation transcends geographic boundaries, suggesting that new approaches to teaching these skills need to be explored. Improved EKG reading skills by family physicians are generally needed in both the United States and the UAE.

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

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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.

Analysis of Medication Errors in Simulated Pediatric Resuscitation by Residents

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Evelyn Porter

2014-07-01

Full Text Available Introduction: The objective of our study was to estimate the incidence of prescribing medication errors specifically made by a trainee and identify factors associated with these errors during the simulated resuscitation of a critically ill child. Methods: The results of the simulated resuscitation are described. We analyzed data from the simulated resuscitation for the occurrence of a prescribing medication error. We compared univariate analysis of each variable to medication error rate and performed a separate multiple logistic regression analysis on the significant univariate variables to assess the association between the selected variables. Results: We reviewed 49 simulated resuscitations . The final medication error rate for the simulation was 26.5% (95% CI 13.7% - 39.3%. On univariate analysis, statistically significant findings for decreased prescribing medication error rates included senior residents in charge, presence of a pharmacist, sleeping greater than 8 hours prior to the simulation, and a visual analog scale score showing more confidence in caring for critically ill children. Multiple logistic regression analysis using the above significant variables showed only the presence of a pharmacist to remain significantly associated with decreased medication error, odds ratio of 0.09 (95% CI 0.01 - 0.64. Conclusion: Our results indicate that the presence of a clinical pharmacist during the resuscitation of a critically ill child reduces the medication errors made by resident physician trainees.

[Burnout in Tunisian medical residents: About 149 cases].

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Ben Zid, A; Homri, W; Ben Romdhane, I; Bram, N; Labbane, R

2017-09-01

Burnout is a professional psychological chronic stress-induced syndrome defined by three dimensions: emotional exhaustion, depersonalization, and low personal accomplishment. This syndrome concerns all professions but especially healthcare staff. Numerous studies have attempted to document the impact of work activities on the doctor's mental health. According to the literature, junior doctors are more vulnerable to develop this syndrome. Are to determine the prevalence of severe burnout among residents of different specialties: anesthesiology, general surgery, emergency medicine, psychiatry, basic sciences. The secondary end points are to analyze risk factors, causes and consequences associated with burnout. A cross-sectional study conducted among medical residents working in hospitals located in the governorates of Tunis. Three instruments were used: an anonymous self-administered questionnaire, Maslach Burnout Inventory (MBI) to assess burnout, and Abstract Beck Depression Inventory to evaluate the intensity of depression. Severe burnout was defined as a severely high level of both emotional exhaustion and depersonalization associated with a severely low level of personal accomplishment. A total of 149 participants (response rate=76.8%) participated in the survey. Among participants, 17.14% (n=26) had a severe burnout. The emergency medicine residents had the highest rate of emotional exhaustion and depersonalization and severe depression. Overall, resident respondents, 31% (n=46), had moderate to severe depression. Among stress factors, those significantly correlated to burnout were: lack of hobbies (Pburnout were: Antecedents of specialty change (P=0.017) and desire for a specialty change (Pburnout was not found. Medical residents in all specialties are at risk of burnout. Nevertheless, this study revealed that some specialties are more exhausting, which is consistent with the results reported in the literature. Moreover, it is shown that several stress factors

Information-seeking Behavior During Residency Is Associated With Quality of Theoretical Learning, Academic Career Achievements, and Evidence-based Medical Practice

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Oussalah, Abderrahim; Fournier, Jean-Paul; Guéant, Jean-Louis; Braun, Marc

2015-01-01

Abstract Data regarding knowledge acquisition during residency training are sparse. Predictors of theoretical learning quality, academic career achievements and evidence-based medical practice during residency are unknown. We performed a cross-sectional study on residents and attending physicians across several residency programs in 2 French faculties of medicine. We comprehensively evaluated the information-seeking behavior (I-SB) during residency using a standardized questionnaire and looked for independent predictors of theoretical learning quality, academic career achievements, and evidence-based medical practice among I-SB components using multivariate logistic regression analysis. Between February 2013 and May 2013, 338 fellows and attending physicians were included in the study. Textbooks and international medical journals were reported to be used on a regular basis by 24% and 57% of the respondents, respectively. Among the respondents, 47% refer systematically (4.4%) or frequently (42.6%) to published guidelines from scientific societies upon their publication. The median self-reported theoretical learning quality score was 5/10 (interquartile range, 3–6; range, 1–10). A high theoretical learning quality score (upper quartile) was independently and strongly associated with the following I-SB components: systematic reading of clinical guidelines upon their publication (odds ratio [OR], 5.55; 95% confidence interval [CI], 1.77–17.44); having access to a library that offers the leading textbooks of the specialty in the medical department (OR, 2.45, 95% CI, 1.33–4.52); knowledge of the specialty leading textbooks (OR, 2.12; 95% CI, 1.09–4.10); and PubMed search skill score ≥5/10 (OR, 1.94; 95% CI, 1.01–3.73). Research Master (M2) and/or PhD thesis enrolment were independently and strongly associated with the following predictors: PubMed search skill score ≥5/10 (OR, 4.10; 95% CI, 1.46–11.53); knowledge of the leading medical journals of the

Understanding the challenges to facilitating active learning in the resident conferences: a qualitative study of internal medicine faculty and resident perspectives.

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Sawatsky, Adam P; Zickmund, Susan L; Berlacher, Kathryn; Lesky, Dan; Granieri, Rosanne

2015-01-01

In the Next Accreditation System, the Accreditation Council for Graduate Medical Education outlines milestones for medical knowledge and requires regular didactic sessions in residency training. There are many challenges to facilitating active learning in resident conferences, and we need to better understand resident learning preferences and faculty perspectives on facilitating active learning. The goal of this study was to identify challenges to facilitating active learning in resident conferences, both through identifying specific implementation barriers and identifying differences in perspective between faculty and residents on effective teaching and learning strategies. The investigators invited core residency faculty to participate in focus groups. The investigators used a semistructured guide to facilitate discussion about learning preferences and teaching perspectives in the conference setting and used an 'editing approach' within a grounded theory framework to qualitative analysis to code the transcripts and analyze the results. Data were compared to previously collected data from seven resident focus groups. Three focus groups with 20 core faculty were conducted. We identified three domains pertaining to facilitating active learning in resident conferences: barriers to facilitating active learning formats, similarities and differences in faculty and resident learning preferences, and divergence between faculty and resident opinions about effective teaching strategies. Faculty identified several setting, faculty, and resident barriers to facilitating active learning in resident conferences. When compared to residents, faculty expressed similar learning preferences; the main differences were in motivations for conference attendance and type of content. Resident preferences and faculty perspectives differed on the amount of information appropriate for lecture and the role of active participation in resident conferences. This study highlights several

Learning from mistakes. Factors that influence how students and residents learn from medical errors.

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Fischer, Melissa A; Mazor, Kathleen M; Baril, Joann; Alper, Eric; DeMarco, Deborah; Pugnaire, Michele

2006-05-01

Trainees are exposed to medical errors throughout medical school and residency. Little is known about what facilitates and limits learning from these experiences. To identify major factors and areas of tension in trainees' learning from medical errors. Structured telephone interviews with 59 trainees (medical students and residents) from 1 academic medical center. Five authors reviewed transcripts of audiotaped interviews using content analysis. Trainees were aware that medical errors occur from early in medical school. Many had an intense emotional response to the idea of committing errors in patient care. Students and residents noted variation and conflict in institutional recommendations and individual actions. Many expressed role confusion regarding whether and how to initiate discussion after errors occurred. Some noted the conflict between reporting errors to seniors who were responsible for their evaluation. Learners requested more open discussion of actual errors and faculty disclosure. No students or residents felt that they learned better from near misses than from actual errors, and many believed that they learned the most when harm was caused. Trainees are aware of medical errors, but remaining tensions may limit learning. Institutions can immediately address variability in faculty response and local culture by disseminating clear, accessible algorithms to guide behavior when errors occur. Educators should develop longitudinal curricula that integrate actual cases and faculty disclosure. Future multi-institutional work should focus on identified themes such as teaching and learning in emotionally charged situations, learning from errors and near misses and balance between individual and systems responsibility.

Interprofessional collaboration between residents and nurses in general internal medicine: a qualitative study on behaviours enhancing teamwork quality.

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Virginie Muller-Juge

Full Text Available BACKGROUND: Effective teamwork is necessary for optimal patient care. There is insufficient understanding of interactions between physicians and nurses on internal medicine wards. OBJECTIVE: To describe resident physicians' and nurses' actual behaviours contributing to teamwork quality in the setting of a simulated internal medicine ward. METHODS: A volunteer sample of 14 pairs of residents and nurses in internal medicine was asked to manage one non-urgent and one urgent clinical case in a simulated ward, using a high-fidelity manikin. After the simulation, participants attended a stimulated-recall session during which they viewed the videotape of the simulation and explained their actions and perceptions. All simulations were transcribed, coded, and analyzed, using a qualitative method (template analysis. Quality of teamwork was assessed, based on patient management efficiency and presence of shared management goals and of team spirit. RESULTS: Most resident-nurse pairs tended to interact in a traditional way, with residents taking the leadership and nurses executing medical prescriptions and assuming their own specific role. They also demonstrated different types of interactions involving shared responsibilities and decision making, constructive suggestions, active communication and listening, and manifestations of positive team building. The presence of a leader in the pair or a truly shared leadership between resident and nurse contributed to teamwork quality only if both members of the pair demonstrated sufficient autonomy. In case of a lack of autonomy of one member, the other member could compensate for it, if his/her own autonomy was sufficiently strong and if there were demonstrations of mutual listening, information sharing, and positive team building. CONCLUSIONS: Although they often relied on traditional types of interaction, residents and nurses also demonstrated readiness for increased sharing of responsibilities. Interprofessional

Interprofessional Collaboration between Residents and Nurses in General Internal Medicine: A Qualitative Study on Behaviours Enhancing Teamwork Quality

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Muller-Juge, Virginie; Cullati, Stéphane; Blondon, Katherine S.; Hudelson, Patricia; Maître, Fabienne; Vu, Nu V.; Savoldelli, Georges L.; Nendaz, Mathieu R.

2014-01-01

Background Effective teamwork is necessary for optimal patient care. There is insufficient understanding of interactions between physicians and nurses on internal medicine wards. Objective To describe resident physicians’ and nurses’ actual behaviours contributing to teamwork quality in the setting of a simulated internal medicine ward. Methods A volunteer sample of 14 pairs of residents and nurses in internal medicine was asked to manage one non-urgent and one urgent clinical case in a simulated ward, using a high-fidelity manikin. After the simulation, participants attended a stimulated-recall session during which they viewed the videotape of the simulation and explained their actions and perceptions. All simulations were transcribed, coded, and analyzed, using a qualitative method (template analysis). Quality of teamwork was assessed, based on patient management efficiency and presence of shared management goals and of team spirit. Results Most resident-nurse pairs tended to interact in a traditional way, with residents taking the leadership and nurses executing medical prescriptions and assuming their own specific role. They also demonstrated different types of interactions involving shared responsibilities and decision making, constructive suggestions, active communication and listening, and manifestations of positive team building. The presence of a leader in the pair or a truly shared leadership between resident and nurse contributed to teamwork quality only if both members of the pair demonstrated sufficient autonomy. In case of a lack of autonomy of one member, the other member could compensate for it, if his/her own autonomy was sufficiently strong and if there were demonstrations of mutual listening, information sharing, and positive team building. Conclusions Although they often relied on traditional types of interaction, residents and nurses also demonstrated readiness for increased sharing of responsibilities. Interprofessional education should

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

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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

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

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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

Permanent resident

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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.

Medical professionalism from a socio-cultural perspective: Evaluating medical residents communicative attitudes during the medical encounter in Malaysia

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K Ganasegeran; SAR Al-Dubai

2014-01-01

Context: The practice of medicine requires good communication skills to foster excellent rapport in doctor patient relationship. Reports on communication skills learning attitude among medical professionals are key essentials toward improving patient safety and quality of care. Aims: We aimed to determine factors affecting communication skills learning attitudes among medical residents in Malaysia. Settings and Design: Cross-sectional survey, in a Malaysian public health hospital. Materials a...

Training-related harassment and drinking outcomes in medical residents versus graduate students.

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Shinsako, S A; Richman, J A; Rospenda, K M

2001-12-01

This study examined the prevalence of sexual harassment and generalized workplace abuse, and their differential effects on drinking behaviors in medical residents and graduate students at an urban American university. While medical residents had greater odds of experiencing harassment and abuse in their training programs, it was found that in most cases their deleterious drinking behaviors decreased, whereas graduate student drinking behaviors increased as a consequence of these experiences. The drinking outcomes of men were more affected by harassment and abuse than those of women.

Readiness for Residency: A Survey to Evaluate Undergraduate Medical Education Programs.

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Peterson, Linda N; Rusticus, Shayna A; Wilson, Derek A; Eva, Kevin W; Lovato, Chris Y

2015-11-01

Health professions programs continue to search for meaningful and efficient ways to evaluate the quality of education they provide and support ongoing program improvement. Despite flaws inherent in self-assessment, recent research suggests that aggregated self-assessments reliably rank aspects of competence attained during preclerkship MD training. Given the novelty of those observations, the purpose of this study was to test their generalizability by evaluating an MD program as a whole. The Readiness for Residency Survey (RfR) was developed and aligned with the published Readiness for Clerkship Survey (RfC), but focused on the competencies expected to be achieved at graduation. The RfC and RfR were administered electronically four months after the start of clerkship and six months after the start of residency, respectively. Generalizability and decision studies examined the extent to which specific competencies were achieved relative to one another. The reliability of scores assigned by a single resident was G = 0.32. However, a reliability of G = 0.80 could be obtained by averaging over as few as nine residents. Whereas highly rated competencies in the RfC resided within the CanMEDS domains of professional, communicator, and collaborator, five additional medical expert competencies emerged as strengths when the program was evaluated after completion by residents. Aggregated resident self-assessments obtained using the RfR reliably differentiate aspects of competence attained over four years of undergraduate training. The RfR and RfC together can be used as evaluation tools to identify areas of strength and weakness in an undergraduate medical education program.

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...

Competencies for first year residents - physicians' views from medical schools with different undergraduate curricula.

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Fürstenberg, Sophie; Schick, Kristina; Deppermann, Jana; Prediger, Sarah; Berberat, Pascal O; Kadmon, Martina; Harendza, Sigrid

2017-09-07

Frameworks like the CanMEDS model depicting professional roles and specific professional activities provide guidelines for postgraduate education. When medical graduates start their residency, they should possess certain competencies related to communication, management and professionalism while other competencies will be refined during postgraduate training. Our study aimed to evaluate the relevance of different competencies for a first year resident required for entrustment decision from the perspective of physicians from medical faculties with different undergraduate medical curricula. Nine hundred fifty-two surgeons and internists from three medical schools with different undergraduate medical curricula were invited to rank 25 competencies according to their relevance for first year residents. The rankings were compared between universities, specialties, physicians' positions, and gender. Two hundred two physicians participated, 76 from Hamburg University, 44 from Oldenburg University, and 82 from Technical University Munich. No significant differences were found regarding the top 10 competencies relevant for first year residents between the universities. 'Responsibility' was the competency with the highest rank overall. Internists ranked 'Structure, work planning and priorities' higher while surgeons ranked 'Verbal communication with colleagues and supervisors' higher. Consultants evaluated 'Active listening to patients' more important than department directors and residents. Female physicians ranked 'Verbal communication with colleagues and supervisors' and 'Structure, work planning and priorities' significantly higher while male physicians ranked 'Scientifically and empirically grounded method of working' significantly higher. Physicians from universities with different undergraduate curricula principally agreed on the competencies relevant for first year residents. Some differences between physicians from different positions, specialties, and gender were

Assessing knowledge and attitudes towards addictions in medical residents of a general hospital

OpenAIRE

Barral, Carmen; Eiroa-Orosa, Francisco Jose; Navarro-Marfisis, Maria Cecilia; Roncero, Carlos; Casas, Miguel

2014-01-01

Addiction treatment training has been recognized to be an essential part of the curriculum in psychiatry and general medicine. Our objective in this study was to measure the knowledge and attitudes towards addictions among medical residents of a general hospital in Catalonia, Spain.\\ud \\ud Method\\ud Within a sample of medical residents, we administered a questionnaire based on previous literature including attitudes towards patients with drug use problems, evaluation of knowledge and beliefs ...

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

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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

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

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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.

Reduction of high levels of internal radio-contamination by dietary intervention in residents of areas affected by the Fukushima Daiichi nuclear plant disaster: a case series.

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Masaharu Tsubokura

medical care providers about risky food intake appears to be a feasible option for changing residents' dietary practices, subsequently resulting in a reduction in Cs internal contamination levels.

Medical tourism services available to residents of the United States.

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Alleman, Brandon W; Luger, Tana; Reisinger, Heather Schacht; Martin, Rene; Horowitz, Michael D; Cram, Peter

2011-05-01

There are growing reports of United States (US) residents traveling overseas for medical care, but empirical data about medical tourism are limited. To characterize the businesses and business practices of entities promoting medical tourism and the types and costs of procedures being offered. DESIGN, PARTICIPANTS, AND OUTCOMES: Between June and August 2008, we conducted a telephone survey of all businesses engaged in facilitating overseas medical travel for US residents. We collected information from each company including: the number of employees; number of patients referred overseas; medical records security processes; destinations to which patients were referred; treatments offered; treatment costs; and whether patient outcomes were collected. We identified 63 medical tourism companies and 45 completed our survey (71%). Companies had a mean of 9.8 employees and had referred an average of 285 patients overseas (a total of approximately 13,500 patients). 35 (79%) companies reported requiring accreditation of foreign providers, 22 (50%) collected patient outcome data, but only 17 (39%) described formal medical records security policies. The most common destinations were India (23 companies, 55%), Costa Rica (14, 33%), and Thailand (12, 29%). The most common types of care included orthopedics (32 companies, 73%), cardiac care (23, 52%), and cosmetic surgery (29, 66%). 20 companies (44%) offered treatments not approved for use in the US--most commonly stem cell therapy. Average costs for common procedures, CABG ($18,600) and knee arthroplasty ($10,800), were similar to previous reports. The number of Americans traveling overseas for medical care with assistance from medical tourism companies is relatively small. Attention to medical records security and patient outcomes is variable and cost-savings are dependent on US prices. That said, overseas medical care can be a reasonable alternative for price sensitive patients in need of relatively common, elective medical

Acculturation Needs of Pediatric International Medical Graduates: A Qualitative Study.

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Osta, Amanda D; Barnes, Michelle M; Pessagno, Regina; Schwartz, Alan; Hirshfield, Laura E

2017-01-01

Phenomenon: International medical graduates (IMGs) play a key role in host countries' health systems but face unique challenges, which makes effective, tailored support for IMGs essential. Prior literature describing the acculturation needs of IMGs focused primarily on communication content and style. We conducted a qualitative study to explore acculturation that might be specific to IMG residents who care for children. In a study conducted from November 2011 to April 2012, we performed four 90-minute semistructured focus groups with 26 pediatric IMG residents from 12 countries. The focus group transcripts were analyzed using open and focused coding methodology. The focus groups and subsequent analysis demonstrated that pediatric IMG residents' socialization to their home culture impacts their transition to practice in the United States; they must adjust not only to a U.S. culture, different from their own, but also to the culture of medicine in the United States. We identified the following new acculturation themes: understanding the education system and family structure, social determinants of health, communication with African American parents, contraception, physician handoffs, physicians' role in prevention, adolescent health, and physicians' role in child advocacy. We further highlight the acculturation challenges faced by pediatric IMG residents and offer brief recommendations for the creation of a deliberate acculturation curriculum for pediatric IMG residents. Insight: Residency training is a unique period in physicians' personal and professional development and can be particularly challenging for IMGs. There is a significant gap in the identified acculturation needs and the current curricula available to IMG residents who care for children.

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

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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

Factors affecting residency rank-listing: A Maxdiff survey of graduating Canadian medical students

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Forgie Melissa

2011-08-01

Full Text Available Abstract Background In Canada, graduating medical students consider many factors, including geographic, social, and academic, when ranking residency programs through the Canadian Residency Matching Service (CaRMS. The relative significance of these factors is poorly studied in Canada. It is also unknown how students differentiate between their top program choices. This survey study addresses the influence of various factors on applicant decision making. Methods Graduating medical students from all six Ontario medical schools were invited to participate in an online survey available for three weeks prior to the CaRMS match day in 2010. Max-Diff discrete choice scaling, multiple choice, and drop-list style questions were employed. The Max-Diff data was analyzed using a scaled simple count method. Data for how students distinguish between top programs was analyzed as percentages. Comparisons were made between male and female applicants as well as between family medicine and specialist applicants; statistical significance was determined by the Mann-Whitney test. Results In total, 339 of 819 (41.4% eligible students responded. The variety of clinical experiences and resident morale were weighed heavily in choosing a residency program; whereas financial incentives and parental leave attitudes had low influence. Major reasons that applicants selected their first choice program over their second choice included the distance to relatives and desirability of the city. Both genders had similar priorities when selecting programs. Family medicine applicants rated the variety of clinical experiences more importantly; whereas specialty applicants emphasized academic factors more. Conclusions Graduating medical students consider program characteristics such as the variety of clinical experiences and resident morale heavily in terms of overall priority. However, differentiation between their top two choice programs is often dependent on social/geographic factors

Mobile Phone Use Among Medical Residents: A Cross-Sectional Multicenter Survey in Saudi Arabia.

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Jamal, Amr; Temsah, Mohamad-Hani; Khan, Samina A; Al-Eyadhy, Ayman; Koppel, Cristina; Chiang, Michael F

2016-05-19

Mobile phones have great potential for medical education, as they allow health care providers and students to access resources efficiently at the precise time at the point-of-care to help in informed decision making. The objective of the study was to evaluate the prevalence of mobile phone usage among medical residents and to explore their attitudes, perceptions, and the challenges they experience when using mobile phones in academic and clinical practice. A cross-sectional survey was conducted on all 133 residents in 17 different specialties across two large academic hospitals in Riyadh, Saudi Arabia. The Web-based validated questionnaire measured mobile phone platform preferences, and their uses in general and medical practice. The perception of confidentiality and safety impact of using mobile phones for communication and accessing patient's data was also explored, alongside challenges of use and how residents learn to use their mobile phone. With a response rate of 101/133 (75.9%) and mean age of 27.8 (SD 3.0) years, we found that 100/101 (99.0%) of participants were mobile phone users with mean duration of use of 5.12 (SD 2.4) years, and a range from 1 to 12 years. There was no significant difference in use between male and female respondents. A negative linear correlation was found between age and use duration (P=.004). The most common operating system used by participants was the iOS platform (55/101, 54.5%), with English the most commonly used language to operate residents' mobile phones (96/100, 96.0%) despite their native language being Arabic. For communication outside medical practice, chatting applications such as WhatsApp matched phone calls as most commonly used tools (each 88/101, 87.1%). These were also the primary tools for medical communication, but used at a lower rate (each 65/101, 64.4%). In medical practice, drug (83/101, 82.2%) and medical (80/101, 79.2%) references and medical calculation applications (61/101, 60.4%) were the most commonly

Acute Stress and Anxiety in Medical Residents on the Emergency Department Duty

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Joaquín M. González-Cabrera

2018-03-01

Full Text Available The objectives of this longitudinal study were to compare salivary cortisol release patterns in medical residents and their self-perceived anxiety levels between a regular working day and a day when on call in the emergency department (ED-duty day and to determine any differences in cortisol release pattern as a function of years of residency or sex. The study included 35 residents (physicians-in-training of the Granada University Hospital, Granada, Spain. Acute stress was measured on a regular working day and an ED-duty day, evaluating anxiety-state with the Spanish version of the State-Trait Anxiety Inventory. Physiological stress assessment was based on salivary cortisol levels. Cortisol release concentrations were higher on an ED-duty day than on a regular working day, with a significantly increased area under the curve (AUC (p < 0.006. This difference slightly attenuated with longer residency experience. No gender difference in anxiety levels was observed (p < 0.001. According to these findings, the hypothalamic-pituitary-adrenal axis activity and anxiety levels of medical residents are higher on an ED-duty day than on a regular working day.

The Transition of Medical Students Through Residency: Effects on Physical Activity and Other Lifestyle-Related Behaviors.

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Pardo, Alba; Mitjans, Anna; Baranda, Lucía; Salamero, Manel; McKenna, James; Arteman, Antoni; Violán, Mariona

2016-05-01

Little is known about lifestyle choices and preventive healthcare-seeking behaviors during the transition from medical school graduation to residency training, a period characterized by increased rates of stress and lack of free time due to demanding working conditions. All of these issues are likely to affect physical activity (PA) level. This study explored the evolution of PA and other lifestyle behaviors during this transition. A cross-sectional study and a cohort study were conducted with medical students (2010) and physicians before and after the first year of residency (2013 and 2014). A self-administered questionnaire assessed PA, health and lifestyle behaviors. From a sample of 420 medical students and 478 residents, 74% comply with current PA guidelines. PA decreased by 16% during residency. Low levels of PA were found among (i) females and in respondents who reported (ii) poor self-perceived health and (iii) unhealthy body weight (P mental health in first-year residents. The transition has a negative effect on physicians' PA level that may affect physicians' own health and patient care. Medical programs should encourage residents to engage in PA to assure physicians' personal and mental health.

Raising the Bar for the Care of Seriously Ill Patients: Results of a National Survey to Define Essential Palliative Care Competencies for Medical Students and Residents

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Schaefer, Kristen G.; Chittenden, Eva H.; Sullivan, Amy M.; Periyakoil, Vyjeyanth S.; Morrison, Laura J.; Carey, Elise C.; Sanchez-Reilly, Sandra; Block, Susan D.

2014-01-01

Purpose Given the shortage of palliative care specialists in the U.S., to ensure quality of care for patients with serious, life-threatening illness, generalist-level palliative care competencies need to be defined and taught. The purpose of this study was to define essential competencies for medical students and internal medicine and family medicine (IM/FM) residents through a national survey of palliative care experts. Method Proposed competencies were derived from existing Hospice and Palliative Medicine fellowship competencies, and revised to be developmentally appropriate for students and residents. In spring 2012, the authors administered a web-based, national cross-sectional survey of palliative care educational experts to assess ratings and rankings of proposed competencies and competency domains. Results The authors identified 18 comprehensive palliative care competencies for medical students and IM/FM residents, respectively. Over 95% of survey respondents judged the competencies as comprehensive and developmentally appropriate (survey response rate=72%, 71/98). Using predefined cut-off criteria, experts identified 7 medical student and 13 IM/FM resident competencies as essential. Communication and pain/symptom management were rated as the most critical domains. Conclusions This national survey of palliative care experts defines comprehensive and essential palliative care competencies for medical students and IM/FM residents that are specific, measurable, and can be used to report educational outcomes; provide a sequence for palliative care curricula in undergraduate and graduate medical education; and highlight the importance of educating medical trainees in communication and pain management. Next steps include seeking input and endorsement from stakeholders in the broader medical education community. PMID:24979171

Raising the bar for the care of seriously ill patients: results of a national survey to define essential palliative care competencies for medical students and residents.

Science.gov (United States)

Schaefer, Kristen G; Chittenden, Eva H; Sullivan, Amy M; Periyakoil, Vyjeyanth S; Morrison, Laura J; Carey, Elise C; Sanchez-Reilly, Sandra; Block, Susan D

2014-07-01

Given the shortage of palliative care specialists in the United States, to ensure quality of care for patients with serious, life-threatening illness, generalist-level palliative care competencies need to be defined and taught. The purpose of this study was to define essential competencies for medical students and internal medicine and family medicine (IM/FM) residents through a national survey of palliative care experts. Proposed competencies were derived from existing hospice and palliative medicine fellowship competencies and revised to be developmentally appropriate for students and residents. In spring 2012, the authors administered a Web-based, national cross-sectional survey of palliative care educational experts to assess ratings and rankings of proposed competencies and competency domains. The authors identified 18 comprehensive palliative care competencies for medical students and IM/FM residents, respectively. Over 95% of survey respondents judged the competencies as comprehensive and developmentally appropriate (survey response rate = 72%, 71/98). Using predefined cutoff criteria, experts identified 7 medical student and 13 IM/FM resident competencies as essential. Communication and pain/symptom management were rated as the most critical domains. This national survey of palliative care experts defines comprehensive and essential palliative care competencies for medical students and IM/FM residents that are specific, measurable, and can be used to report educational outcomes; provide a sequence for palliative care curricula in undergraduate and graduate medical education; and highlight the importance of educating medical trainees in communication and pain management. Next steps include seeking input and endorsement from stakeholders in the broader medical education community.

Plagiarism in residency application essays.

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Segal, Scott; Gelfand, Brian J; Hurwitz, Shelley; Berkowitz, Lori; Ashley, Stanley W; Nadel, Eric S; Katz, Joel T

2010-07-20

Anecdotal reports suggest that some residency application essays contain plagiarized content. To determine the prevalence of plagiarism in a large cohort of residency application essays. Retrospective cohort study. 4975 application essays submitted to residency programs at a single large academic medical center between 1 September 2005 and 22 March 2007. Specialized software was used to compare residency application essays with a database of Internet pages, published works, and previously submitted essays and the percentage of the submission matching another source was calculated. A match of more than 10% to an existing work was defined as evidence of plagiarism. Evidence of plagiarism was found in 5.2% (95% CI, 4.6% to 5.9%) of essays. The essays of non-U.S. citizens were more likely to demonstrate evidence of plagiarism. Other characteristics associated with the prevalence of plagiarism included medical school location outside the United States and Canada; previous residency or fellowship; lack of research experience, volunteer experience, or publications; a low United States Medical Licensing Examination Step 1 score; and non-membership in the Alpha Omega Alpha Honor Medical Society. The software database is probably incomplete, the 10%-match threshold for defining plagiarism has not been statistically validated, and the study was confined to applicants to 1 institution. Evidence of matching content in an essay cannot be used to infer the applicant's intent and is not sensitive to variations in the cultural context of copying in some societies. Evidence of plagiarism in residency application essays is more common in international applicants but was found in those by applicants to all specialty programs, from all medical school types, and even among applicants with significant academic honors. No external funding.

International medical cooperation project for State of Libya using international medical tourism system in Thailand

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奥寺, 敬; 坂本, 美重

2013-01-01

International medical cooperation project for State of Libya is reported. The concept of this project is to treat Libyan injured people using international medical tourism system in Thailand. Management of patient, including evaluation, domestic and international transportation arrangement of hospital, is supported by Normeca International Co., Ltd, (Pattaya, Thailand). Treatment of Libyan patient in two international hospitals (Bangpakok 9 Hospital and Navamin 9 Hopsital) in Bangkok was succ...

Otolaryngology residency selection process. Medical student perspective.

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Stringer, S P; Cassisi, N J; Slattery, W H

1992-04-01

In an effort to improve the otolaryngology matching process at the University of Florida, Gainesville, we sought to obtain the medical student's perspective of the current system. All students who interviewed here over a 3-year period were surveyed regarding the application, interview, and ranking process. In addition, suggestions for improving the system were sought from the students. The application and interviewing patterns of the students surveyed were found to be similar to those of the entire otolaryngology residency applicant pool. We were unable to identify any factors that influence a student's rank list that could be prospectively used to help select applicants for interview. A variety of suggestions for improvements in the match were received, several of which could easily be instituted. A uniform interview invitation date as requested by the students could be rapidly implemented and would provide benefits for both the students and the residency programs.

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

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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.

Medication Use and Its Potential Impact on the Oral Health Status of Nursing Home Residents in Flanders (Belgium).

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Janssens, Barbara; Petrovic, Mirko; Jacquet, Wolfgang; Schols, Jos M G A; Vanobbergen, Jacques; De Visschere, Luc

2017-09-01

Polypharmacy is considered the most important etiologic factor of hyposalivation, which in turn can initiate oral health problems. To describe the medication use of nursing home residents, to identify the medications related to hyposalivation and to find possible associations between the different classes of medication, the number of medications, and the oral health status of the residents. A cross-sectional study. The study population consisted of the residents of a nonrandom sample of 23 nursing homes from 2 Belgian provinces, belonging to the oral health care network Gerodent. All residents of the sample visited the Gerodent mobile dental clinic between October 2010 and April 2012. For each resident, oral health data, demographic data, and an overview of the total medication intake were collected. The study sample consisted of 1226 nursing home residents with a mean age of 83.9 years [standard deviation (SD) 8.5]. The mean number of medications per person was 9.0 (SD 3.6, range 0-23, median 9.0). Of all prescribed medication, 49.6% had a potential hyposalivatory effect with a mean number per person of 4.5 (SD 2.2, range 0-15, median 4.0). In the bivariate analyses, associations were found between medication use and oral health of residents with natural teeth: the higher the number of medications (with risk of dry mouth) and the overall risk of medication-related dry mouth, the lower the number of natural teeth (P = .022, P = .005, and P = .017, respectively). In contrast, the total treatment need tended to decrease with rising medication intake, resulting in a clear increase of the treatment index with rising medication intake (P = .003, P oral status of the residents. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

[Burnout syndrome among medical residents during the influenza A H1N1 sanitary contigency in Mexico].

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Austria-Corrales, Fernando; Cruz-Valdés, Beatriz; Herrera-Kiengelher, Loredmy; Vázquez-García, Juan Carlos; Salas-Hernández, Jorge

2011-01-01

To measure the degree of stress among medical residents at a Third Level Hospital in Mexico City during the sanitary contingency caused by the AH1N1 influenza virus. A transversal descriptive study with a non-probabilistic sample of 99 medical residents with different fields of specialization related to respiratory medicine. Researchers applied the Maslach Burnout Inventory questionnaire to evaluate three dimensions: emotional fatigue, depersonalization, and personal fulfillment. The survey was self-administered and anonymous, and the study was conducted during the first AH1N1 influenza virus outbreak (April 23 to May 10, 2009). During that period, the hospital underwent a process of reorganization that included cancelling vacation periods for all medical residents and adjusting duty rosters. The highest proportion of medical residents with burnout syndrome was those in their second year of specialization in the area of pneumology. Results also showed that medical residents under 30 years of age had a higher probability of presenting burnout syndrome. No significant differences were found regarding the residents’ place of origin.

Communication Skills Curriculum for Foreign Medical Graduates in an Internal Medicine Residency Program

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Ramaswamy, Ravishankar; Williams, Alicia; Clark, Elizabeth M.; Kelley, Amy S.

2014-01-01

Background Effective communication is an important aspect of caring for the elderly, who are more likely to have multimorbidity, limited health literacy and psychosocial barriers to care. About half of Internal Medicine (IM) trainees in the United States are foreign medical graduates, and may not have been exposed to prior communication skills education. This novel communication skills curriculum for IM interns aimed to increase trainees' confidence and use of specific communication tools with older adults, particularly in delivering bad news and conducting family meetings. Methods The workshop consisted of 2 interactive sessions, in a small group with 2 learners and 1-2 facilitators, during the Geriatrics block of the internship year. Twenty-three IM interns were surveyed at the beginning and at the end of the 4-week block and at 3 months after completion of the workshop about their knowledge, confidence and skill in communication, and asked about any challenges to effective communication with older patients. The primary outcome measure was change in self-reported confidence and behavior in communication at 4 weeks. Results On a 4-point Likert scale, there was an average improvement of 0.70 in self-reported confidence in communication, which sustained at 3 months after completion of the workshop. Participants reported several patient, physician and system barriers to effective communication. Conclusion Communication skills education in a small-group setting and the opportunity for repeated practice and self-reflection resulted in sustained increase in overall confidence among IM interns in communication with older adults, and may help overcome certain patient and physician-specific communication barriers. PMID:25354834

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

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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.

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

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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…

International Medical Graduates in Radiation Oncology: Historical Trends and Comparison With Other Medical Specialties

Energy Technology Data Exchange (ETDEWEB)

Verma, Vivek, E-mail: vivek333@gmail.com [Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska (United States); Shah, Chirag [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Lautenschlaeger, Tim [Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana (United States); Lin, Chi [Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska (United States); Beriwal, Sushil [Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); Zhen, Weining [Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska (United States); Mehta, Minesh P. [Department of Radiation Oncology, Miami Cancer Institute, Coral Gables, Florida (United States); Zietman, Anthony L. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)

2016-07-15

Purpose: This is the first National Resident Matching Program analysis evaluating historical patterns of international medical graduates (IMGs) in radiation oncology (RO) and providing comparison with American (MD) medical graduates (AMGs), osteopathic students (DOs), unfilled positions, and other specialties. Methods and Materials: National Resident Matching Program data for IMGs were available from 2003 to 2015, with limited data for other specialty matches. The following RO-specific figures were obtained per year: total positions available; total matched positions; number of unfilled positions; and number of IMG, AMG, and DO matches. In addition, the number of IMG matches and total matched positions were obtained for 19 other specialties. Fisher exact tests and χ{sup 2} tests were considered significant at α <.05. Results: From 2010 to 2015, 0.8% of RO matches were IMGs, a decline from 2.4% in 2003 to 2009 (P=.006). Proportions of DO matches during these intervals increased by 40% (from 1.0% to 1.4%), significantly lower than IMGs for 2003 to 2009 (P=.03) but not 2010 to 2015 (P=.26). From 2003 to 2015, the percentage of IMG matches, at 1.5%, was significantly lower than the percentage of unfilled seats, at 3.5% (P<.001). In comparison with other specialties (2003-2015), RO had the fewest IMG matches (1.5%), followed by otolaryngology (1.9%) and orthopedics (2.2%); specialties with the highest IMG proportions were internal medicine (37.1%), family medicine (35.7%), and neurology (31.1%). Conclusions: Presently, IMGs represent <1% of RO matches, the lowest among major specialties. There are several speculative factors associated with this low proportion. There are significantly more unfilled positions than those filled by IMGs; programs at risk of not matching could weigh the advantages and disadvantages of interviewing IMGs.

Development of a Comprehensive Communication Skills Curriculum for Pediatrics Residents.

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Peterson, Eleanor B; Boland, Kimberly A; Bryant, Kristina A; McKinley, Tara F; Porter, Melissa B; Potter, Katherine E; Calhoun, Aaron W

2016-12-01

Effective communication is an essential element of medical care and a priority of medical education. Specific interventions to teach communication skills are at the discretion of individual residency programs. We developed the Resident Communication Skills Curriculum (RCSC), a formal curriculum designed to teach trainees the communication skills essential for high-quality practice. A multidisciplinary working group contributed to the development of the RCSC, guided by an institutional needs assessment, literature review, and the Accreditation Council for Graduate Medical Education core competencies. The result was a cohesive curriculum that incorporates didactic, role play, and real-life experiences over the course of the entire training period. Methods to assess curricular outcomes included self-reporting, surveys, and periodic faculty evaluations of the residents. Curricular components have been highly rated by residents (3.95-3.97 based on a 4-point Likert scale), and residents' self-reported communication skills demonstrated an improvement over the course of residency in the domains of requesting a consultation, providing effective handoffs, handling conflict, and having difficult conversations (intern median 3.0, graduate median 4.0 based on a 5-point Likert scale, P  ≤ .002). Faculty evaluations of residents have also demonstrated improvement over time (intern median 3.0, graduate median 4.5 based on a 5-point Likert scale, P  communication skills curriculum for pediatrics residents was implemented, with a multistep evaluative process showing improvement in skills over the course of the residency program. Positive resident evaluations and informal comments from faculty support its general acceptance. The use of existing resources makes this curriculum feasible.

Information-seeking behavior during residency is associated with quality of theoretical learning, academic career achievements, and evidence-based medical practice: a strobe-compliant article.

Science.gov (United States)

Oussalah, Abderrahim; Fournier, Jean-Paul; Guéant, Jean-Louis; Braun, Marc

2015-02-01

Data regarding knowledge acquisition during residency training are sparse. Predictors of theoretical learning quality, academic career achievements and evidence-based medical practice during residency are unknown. We performed a cross-sectional study on residents and attending physicians across several residency programs in 2 French faculties of medicine. We comprehensively evaluated the information-seeking behavior (I-SB) during residency using a standardized questionnaire and looked for independent predictors of theoretical learning quality, academic career achievements, and evidence-based medical practice among I-SB components using multivariate logistic regression analysis. Between February 2013 and May 2013, 338 fellows and attending physicians were included in the study. Textbooks and international medical journals were reported to be used on a regular basis by 24% and 57% of the respondents, respectively. Among the respondents, 47% refer systematically (4.4%) or frequently (42.6%) to published guidelines from scientific societies upon their publication. The median self-reported theoretical learning quality score was 5/10 (interquartile range, 3-6; range, 1-10). A high theoretical learning quality score (upper quartile) was independently and strongly associated with the following I-SB components: systematic reading of clinical guidelines upon their publication (odds ratio [OR], 5.55; 95% confidence interval [CI], 1.77-17.44); having access to a library that offers the leading textbooks of the specialty in the medical department (OR, 2.45, 95% CI, 1.33-4.52); knowledge of the specialty leading textbooks (OR, 2.12; 95% CI, 1.09-4.10); and PubMed search skill score ≥5/10 (OR, 1.94; 95% CI, 1.01-3.73). Research Master (M2) and/or PhD thesis enrolment were independently and strongly associated with the following predictors: PubMed search skill score ≥5/10 (OR, 4.10; 95% CI, 1.46-11.53); knowledge of the leading medical journals of the specialty (OR, 3.33; 95

Burnout in medical residents: a study based on the job demands-resources model.

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Zis, Panagiotis; Anagnostopoulos, Fotios; Sykioti, Panagiota

2014-01-01

Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job. The purpose of our cross-sectional study was to estimate the burnout rates among medical residents in the largest Greek hospital in 2012 and identify factors associated with it, based on the job demands-resources model (JD-R). Job demands were examined via a 17-item questionnaire assessing 4 characteristics (emotional demands, intellectual demands, workload, and home-work demands' interface) and job resources were measured via a 14-item questionnaire assessing 4 characteristics (autonomy, opportunities for professional development, support from colleagues, and supervisor's support). The Maslach Burnout Inventory (MBI) was used to measure burnout. Of the 290 eligible residents, 90.7% responded. In total 14.4% of the residents were found to experience burnout. Multiple logistic regression analysis revealed that each increased point in the JD-R questionnaire score regarding home-work interface was associated with an increase in the odds of burnout by 25.5%. Conversely, each increased point for autonomy, opportunities in professional development, and each extra resident per specialist were associated with a decrease in the odds of burnout by 37.1%, 39.4%, and 59.0%, respectively. Burnout among medical residents is associated with home-work interface, autonomy, professional development, and resident to specialist ratio.

Mobile Phone Use Among Medical Residents: A Cross-Sectional Multicenter Survey in Saudi Arabia

Science.gov (United States)

Temsah, Mohamad-Hani; Khan, Samina A; Al-Eyadhy, Ayman; Chiang, Michael F

2016-01-01

Background Mobile phones have great potential for medical education, as they allow health care providers and students to access resources efficiently at the precise time at the point-of-care to help in informed decision making. Objective The objective of the study was to evaluate the prevalence of mobile phone usage among medical residents and to explore their attitudes, perceptions, and the challenges they experience when using mobile phones in academic and clinical practice. Methods A cross-sectional survey was conducted on all 133 residents in 17 different specialties across two large academic hospitals in Riyadh, Saudi Arabia. The Web-based validated questionnaire measured mobile phone platform preferences, and their uses in general and medical practice. The perception of confidentiality and safety impact of using mobile phones for communication and accessing patient’s data was also explored, alongside challenges of use and how residents learn to use their mobile phone. Results With a response rate of 101/133 (75.9%) and mean age of 27.8 (SD 3.0) years, we found that 100/101 (99.0%) of participants were mobile phone users with mean duration of use of 5.12 (SD 2.4) years, and a range from 1 to 12 years. There was no significant difference in use between male and female respondents. A negative linear correlation was found between age and use duration (P=.004). The most common operating system used by participants was the iOS platform (55/101, 54.5%), with English the most commonly used language to operate residents’ mobile phones (96/100, 96.0%) despite their native language being Arabic. For communication outside medical practice, chatting applications such as WhatsApp matched phone calls as most commonly used tools (each 88/101, 87.1%). These were also the primary tools for medical communication, but used at a lower rate (each 65/101, 64.4%). In medical practice, drug (83/101, 82.2%) and medical (80/101, 79.2%) references and medical calculation

Establishing the need and identifying goals for a curriculum in medical business ethics: a survey of students and residents at two medical centers in Missouri.

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Kraus, Elena M; Bakanas, Erin; Gursahani, Kamal; DuBois, James M

2014-10-09

In recent years, issues in medical business ethics (MBE), such as conflicts of interest (COI), Medicare fraud and abuse, and the structure and functioning of reimbursement systems, have received significant attention from the media and professional associations in the United States. As a result of highly publicized instances of financial interests altering physician decision-making, major professional organizations and government bodies have produced reports and guidelines to encourage self-regulation and impose rules to limit physician relationships with for-profit entities. Nevertheless, no published curricula exist in the area of MBE. This study aimed to establish a baseline level of knowledge and the educational goals medical students and residents prioritize in the area of MBE. 732 medical students and 380 residents at two academic medical centers in the state of Missouri, USA, completed a brief survey indicating their awareness of major MBE guidance documents, knowledge of key MBE research, beliefs about the goals of an education in MBE, and the areas of MBE they were most interested in learning more about. Medical students and residents had little awareness of recent and major reports on MBE topics, and had minimal knowledge of basic MBE facts. Residents scored statistically better than medical students in both of these areas. Medical students and residents were in close agreement regarding the goals of an MBE curriculum. Both groups showed significant interest in learning more about MBE topics with an emphasis on background topics such as "the business aspects of medicine" and "health care delivery systems". The content of major reports by professional associations and expert bodies has not trickled down to medical students and residents, yet both groups are interested in learning more about MBE topics. Our survey suggests potentially beneficial ways to frame and embed MBE topics into the larger framework of medical education.

FREQUENCY AND PATTERN OF HEADACHE IN MEDICAL RESIDENTS AND NON-MEDICAL STUDENTS IN A TERTIARY CARE TEACHING HOSPITAL IN NORTH INDIA

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Ruchika Tandon

2018-02-01

Full Text Available BACKGROUND Headache is quite prevalent in general population. Few studies have been done on medical residents and comparison between headache prevalence and types in medical and non-medical student groups is quite lacking. This institute having medical residents as well as non-medical students, provides an opportunity to study and compare frequency and pattern of headache in these student groups. The study was aimed at finding out the type and frequency of headache, disability due to headache and treatment practices followed by these two student groups and the effect on the quality of life of our work force resulting from headache. MATERIALS AND METHODS Headache characteristics were studied in 200 medical residents and non-medical students who had at least one episode of headache of at least moderate intensity in the last 1 year using structured questionnaire. RESULTS Headache occurred in 81% students (79.9% of males and 83.9% of females, of whom, 81.82% were medical, 77.14% were non-medical, 79.65% were married and 82.76% were unmarried. Episodic tension-type headache (TTH was most frequent headache type and migraine without aura was uncommon. More males had TTH than females (55.6% versus 39.3% and migraine was more common in females (39.3% versus 20.1%. Common triggers for headache in medical students were stress, lack of sleep and in non-medical students were stress, sunshine and loud noise. Only 10.5% students were on prescription drugs while 69.8% were self-medicating. CONCLUSION Headache is almost as frequent in medical as in non-medical students and it affects the quality of life of our work force

Self-perceived competence among medical residents in skills needed to care for patients with advanced dementia versus metastatic cancer.

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Manu, Erika; Marks, Adam; Berkman, Cathy S; Mullan, Patricia; Montagnini, Marcos; Vitale, Caroline A

2012-06-01

To examine medical residents' perceived competence in caring for patients with dementia we conducted an online survey of all 120 second, third and fourth-year residents in Internal Medicine, Medicine/Pediatrics, and Family Medicine at University of Michigan. A structured survey elicited residents' training, experience, confidence, and perceived career needs for skills in estimating prognosis, symptom management, and communication in caring for patients with dementia, compared to patients with metastatic cancer. Among the 61 (51 %) respondents, a majority report lower confidence in assessing prognosis and eliciting treatment wishes in patients with dementia (vs. metastatic cancer), and in performing skills integral to the care of patients with dementia, including the ability to assess caregiver needs, decisional capacity, advise on place of care, and manage agitation, despite viewing these skills as important to their future careers. These findings support the need for enhanced education on optimal care of patients with advanced dementia.

Gaps in Radiation Therapy Awareness: Results From an Educational Multi-institutional Survey of US Internal Medicine Residents.

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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

Discontinuing Inappropriate Medication Use in Nursing Home Residents : A Cluster Randomized Controlled Trial

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Wouters, Hans; Scheper, Jessica; Koning, Hedi; Brouwer, Chris; Twisk, Jos W.; van der Meer, Helene; Boersma, Froukje; Zuidema, Sytse U.; Taxis, Katja

2017-01-01

Background: Inappropriate prescribing is a well-known clinical problem in nursing home residents, but few interventions have focused on reducing inappropriate medication use. Objective: To examine successful discontinuation of inappropriate medication use and to improve prescribing in nursing home

Resident and Staff Satisfaction of Pediatric Graduate Medical Education Training on Transition to Adult Care of Medically Complex Patients.

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Weeks, Matthew; Cole, Brandon; Flake, Eric; Roy, Daniel

2018-04-11

This study aims to describe the quantity and satisfaction current residents and experienced pediatricians have with graduate medical education on transitioning medically complex patients to adult care. There is an increasing need for transitioning medically complex adolescents to adult care. Over 90% now live into adulthood and require transition to adult healthcare providers. The 2010 National Survey of Children with Special Health Care Needs found that only 40% of youth 12-17 yr receive the necessary services to appropriately transition to adult care. Prospective, descriptive, anonymous, web-based survey of pediatric residents and staff pediatricians at Army pediatric residency training programs was sent in March 2017. Questions focused on assessing knowledge of transition of care, satisfaction with transition training, and amount of education on transition received during graduate medical education training. Of the 145 responders (310 potential responders, 47% response rate), transition was deemed important with a score of 4.3 out of 5. The comfort level with transition was rated 2.6/5 with only 4.2% of participants receiving formal education during residency. The most commonly perceived barriers to implementing a curriculum were time constraints and available resources. Of the five knowledge assessment questions, three had a correct response rate of less than 1/3. The findings show the disparity between the presence of and perceived need for a formal curriculum on transitioning complex pediatric patients to adult care. This study also highlighted the knowledge gap of the transition process for novice and experienced pediatricians alike.

International medical graduate-patient communication: a qualitative analysis of perceived barriers.

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Dorgan, Kelly A; Lang, Forrest; Floyd, Michael; Kemp, Evelyn

2009-11-01

International medical graduates (IMGs) represent a substantial portion of all medical residents in the United States. Yet, IMGs may be disadvantaged in their communications with U.S. patients for a variety of reasons. The authors conducted a qualitative study to examine IMGs' perceptions of the barriers to their communication with patients. A convenience sample of 12 IMGs participated in interviews that lasted 1 to 1.5 hours. Residents from the Caribbean, Colombia, Denmark, India, Iran, Pakistan, and Peru participated in individual interviews conducted on-site at one of three clinics. Interviews were transcribed and then coded independently and jointly. The authors used a qualitative analysis of interview transcripts to identify primary and secondary themes. IMGs' perceptions of the barriers to communication with their Appalachian patients fit into two broad themes: educational barriers and interpersonal barriers. Within each of these themes, the authors identified secondary themes: education-related barriers were science immersion and lack of communication training, and interpersonally related barriers were unfamiliar dialects, new power dynamics, and different rapport-building expectations. The analysis of the interview data yielded several important findings that residency programs should consider when designing orientations, training curricula, and communication interventions. Programs may need to address challenges related to regional dialect and "informal" English use, as well as communication barriers associated with cross-cultural differences in norms, values, and beliefs. Programs also need to draw on multilayered interventions to address the multidimensional challenges of cross-cultural physician-patient communication.

Health financing and integration of urban and rural residents' basic medical insurance systems in China.

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Zhu, Kun; Zhang, Luying; Yuan, Shasha; Zhang, Xiaojuan; Zhang, Zhiruo

2017-11-07

China is in the process of integrating the new cooperative medical scheme (NCMS) and the urban residents' basic medical insurance system (URBMI) into the urban and rural residents' basic medical insurance system (URRBMI). However, how to integrate the financing policies of NCMS and URBMI has not been described in detail. This paper attempts to illustrate the differences between the financing mechanisms of NCMS and URBMI, to analyze financing inequity between urban and rural residents and to identify financing mechanisms for integrating urban and rural residents' medical insurance systems. Financing data for NCMS and URBMI (from 2008 to 2015) was collected from the China health statistics yearbook, the China health and family planning statistics yearbook, the National Handbook of NCMS Information, the China human resources and social security statistics yearbook, and the China social security yearbook. "Ability to pay" was introduced to measure inequity in health financing. Individual contributions to NCMS and URBMI as a function of per capita disposable income was used to analyze equity in health financing between rural and urban residents. URBMI had a financing mechanism that was similar to that used by NCMS in that public finance accounted for more than three quarters of the pooling funds. The scale of financing for NCMS was less than 5% of the per capita net income of rural residents and less than 2% of the per capita disposable income of urban residents for URBMI. Individual contributions to the NCMS and URBMI funds were less than 1% of their disposable and net incomes. Inequity in health financing between urban and rural residents in China was not improved as expected with the introduction of NCMS and URBMI. The role of the central government and local governments in financing NCMS and URBMI was oscillating in the past decade. The scale of financing for URRBMI is insufficient for the increasing demands for medical services from the insured. The pooling fund

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

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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.

Examination to assess the clinical examination and documentation of spine pathology among orthopedic residents.

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Haglin, Jack M; Zeller, John L; Egol, Kenneth A; Phillips, Donna P

2017-12-01

The Accreditation Council for Graduate Medical Education (ACGME) guidelines requires residency programs to teach and evaluate residents in six overarching "core competencies" and document progress through educational milestones. To assess the progress of orthopedic interns' skills in performing a history, physical examination, and documentation of the encounter for a standardized patient with spinal stenosis, an objective structured clinical examination (OSCE) was conducted for 13 orthopedic intern residents, following a 1-month boot camp that included communications skills and curriculum in history and physical examination. Interns were objectively scored based on their performance of the physical examination, communication skills, completeness and accuracy of their electronic medical record (EMR), and their diagnostic conclusions gleaned from the patient encounter. The purpose of this study was to meaningfully assess the clinical skills of orthopedic post-graduate year (PGY)-1 interns. The findings can be used to develop a standardized curriculum for documenting patient encounters and highlight common areas of weakness among orthopedic interns with regard to the spine history and physical examination and conducting complete and accurate clinical documentation. A major orthopedic specialty hospital and academic medical center. Thirteen PGY-1 orthopedic residents participated in the OSCE with the same standardized patient presenting with symptoms and radiographs consistent with spinal stenosis. Videos of the encounters were independently viewed and objectively evaluated by one investigator in the study. This evaluation focused on the completeness of the history and the performance and completion of the physical examination. The standardized patient evaluated the communication skills of each intern with a separate objective evaluation. Interns completed these same scoring guides to evaluate their own performance in history, physical examination, and communications

Perspective of ophthalmology residents in the United States about residency programs and competency in relation to the International Council of Ophthalmology guidelines.

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Abdelfattah, Nizar Saleh; Radwan, Ahmed E; Sadda, Srinivas R

2016-09-01

To evaluate the perspective of ophthalmology residents in the US about their residency programs and compare the competency of residency programs to international competency levels set by the International Council of Ophthalmology (ICO). A cross-sectional web-based survey extracted from the ICO published competency standards was sent to program directors of ophthalmology residency programs in the US to forward it to current PGY-3, 4 residents, and residency graduates from 2011 to 2014. Eighty-seven responses were received, comprising 61 residents and 26 graduates. Most respondents were highly satisfied with their programs (93.6%). Clinic-based training was rated satisfactorily. Insufficient exposure to low-vision rehabilitation (38.5%), refraction and contact lenses prescription (38.5%), and vitreo-retinal surgeries (38.5%) was reported. Respondents were satisfied with their overall surgical experiences, with the vast majority (>83%) rating case volume, complexity, and variety as satisfactory or better. A significant group stated they had insufficient exposure to extra-capsular cataract extraction (26.3%), refractive surgery (19.7%), and orbital surgery (64.5%). All graduates surveyed passed their Ophthalmic Knowledge Assessment Program (OKAP) examinations, and 72% felt their residency programs adequately prepared them for the examinations. All respondents reported insufficient training in certain nonclinical areas, such as practice management, staffing, and administration skills. Ophthalmology residents in the US express high levels of satisfaction with their residency training programs. While most programs adequately address most ICO core objectives, certain curriculum modifications should be considered.

International Medical Graduates in the US Physician Workforce and Graduate Medical Education: Current and Historical Trends.

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Ahmed, Awad A; Hwang, Wei-Ting; Thomas, Charles R; Deville, Curtiland

2018-04-01

Data show that international medical graduates (IMGs), both US and foreign born, are more likely to enter primary care specialties and practice in underserved areas. Comprehensive assessments of representation trends for IMGs in the US physician workforce are limited. We reported current and historical representation trends for IMGs in the graduate medical education (GME) training pool and US practicing physician workforce. We compared representation for the total GME and active practicing physician pools with the 20 largest residency specialties. A 2-sided test was used for comparison, with P  < .001 considered significant. To assess significant increases in IMG GME trainee representation for the total pool and each of the specialties from 1990-2015, the slope was estimated using simple linear regression. IMGs showed significantly greater representation among active practicing physicians in 4 specialties: internal medicine (39%), neurology (31%), psychiatry (30%), and pediatrics (25%). IMGs in GME showed significantly greater representation in 5 specialties: pathology (39%), internal medicine (39%), neurology (36%), family medicine (32%), and psychiatry (31%; all P  < .001). Over the past quarter century, IMG representation in GME has increased by 0.2% per year in the total GME pool, and 1.1% per year for family medicine, 0.5% for obstetrics and gynecology and general surgery, and 0.3% for internal medicine. IMGs make up nearly a quarter of the total GME pool and practicing physician workforce, with a disproportionate share, and larger increases over our study period in certain specialties.

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

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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.

The Impact of Library Resources and Services on the Scholarly Activity of Medical Faculty and Residents.

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Quesenberry, Alexandria C; Oelschlegel, Sandy; Earl, Martha; Leonard, Kelsey; Vaughn, Cynthia J

2016-01-01

Librarians at an academic medical center library gathered data to determine if library services and resources impacted scholarly activity. A survey was developed and sent out to faculty and residents asking how they used the library during scholarly activity. Sixty-five faculty members and residents responded to the survey. The majority of respondents involved with scholarly activity use the library's services and resources. PubMed is the most frequently used database. The positive results show the library impacts the scholarly activity of medical faculty and residents.

Prevalence of burnout syndrome among medical residents: experience of a developing country.

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Ashkar, Khalil; Romani, Maya; Musharrafieh, Umayya; Chaaya, Monique

2010-05-01

It has been well established that burnout, defined as emotional exhaustion (EE), de-personalisation (DP), and a 'decreased sense of personal accomplishment (PA) due to work related stress', is prevalent to a great extent among medical residents. This has been implicated in the delivery of suboptimal patient care. Residents in developing countries work under difficult working and social conditions and therefore examining burnout is important when addressing quality of care and working conditions. The objectives of the study were to assess the point prevalence of burnout among residents in Lebanon and investigate some of the work and non-work related factors associated with burnout. A cross sectional study of all medical residents was carried out in two major hospitals in the capital city. A total of 155 residents responded, representing all specialities. Maslach Burnout Inventory for Health Services Workers (MBI-HSS) was used. Burnout in three domains was dichotomised into high versus not high burnout. The prevalence of burnout was high in all the domains with the highest in the domain of emotional exhaustion (67.7%). 80% of the sample had a high level of burnout in at least one domain. Being female, experiencing a major stress, working for more than 80 h per week, and having more than eight calls per month increased the odds of burnout in at least one domain. The high burnout level calls for action. This could be addressed by re-examining workload and other working conditions of residents as well as attending to their psychological wellbeing. The limitations of the study are also discussed.

Burnout in Medical Residents: A Study Based on the Job Demands-Resources Model

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Panagiotis Zis

2014-01-01

Full Text Available Purpose. Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job. The purpose of our cross-sectional study was to estimate the burnout rates among medical residents in the largest Greek hospital in 2012 and identify factors associated with it, based on the job demands-resources model (JD-R. Method. Job demands were examined via a 17-item questionnaire assessing 4 characteristics (emotional demands, intellectual demands, workload, and home-work demands’ interface and job resources were measured via a 14-item questionnaire assessing 4 characteristics (autonomy, opportunities for professional development, support from colleagues, and supervisor’s support. The Maslach Burnout Inventory (MBI was used to measure burnout. Results. Of the 290 eligible residents, 90.7% responded. In total 14.4% of the residents were found to experience burnout. Multiple logistic regression analysis revealed that each increased point in the JD-R questionnaire score regarding home-work interface was associated with an increase in the odds of burnout by 25.5%. Conversely, each increased point for autonomy, opportunities in professional development, and each extra resident per specialist were associated with a decrease in the odds of burnout by 37.1%, 39.4%, and 59.0%, respectively. Conclusions. Burnout among medical residents is associated with home-work interface, autonomy, professional development, and resident to specialist ratio.

An elderly person in the attitudes of medical students and medical residents: an ethical aspect

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Fakhrudinova E.R.

2017-06-01

Full Text Available The objective of the study: to identify the attitudes towards elderly among the students and residents of SSMU n.a. V. I. Razumovsky. Material and Methods. Students of 3d and 6th courses and interns of 1st and 2d years (N=85 enrolled in the SSMU n.a. V. I. Razumovsky were involved in the research. The average age of respondents was 21 ±1.8 years. We used the technique of unfinished sentences, which allowed us to measure emotional load of the semantic field of the phenomenon of old age. Results. Among the respondents, most commonly old age is associated with responsibilities in the upbringing of grandchildren, wisdom and pension. The main reasons that hamper the interaction with the elderly respondents emphasized the conflict of older people and a decrease in cognitive functions. Conclusions. In the researched population there is mainly a positive image of old age. Medical students should be prepared to work with older people and a tolerant attitude to old age should be formed

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

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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

Internal Medicine Residents' Beliefs, Attitudes, and Experiences Relating to Palliative Care: A Qualitative Study.

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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.

Clinical and Educational Outcomes of an Integrated Inpatient Quality Improvement Curriculum for Internal Medicine Residents.

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Ogrinc, Greg; Cohen, Emily S; van Aalst, Robertus; Harwood, Beth; Ercolano, Ellyn; Baum, Karyn D; Pattison, Adam J; Jones, Anne C; Davies, Louise; West, Al

2016-10-01

Integrating teaching and hands-on experience in quality improvement (QI) may increase the learning and the impact of resident QI work. We sought to determine the clinical and educational impact of an integrated QI curriculum. This clustered, randomized trial with early and late intervention groups used mixed methods evaluation. For almost 2 years, internal medicine residents from Dartmouth-Hitchcock Medical Center on the inpatient teams at the White River Junction VA participated in the QI curriculum. QI project effectiveness was assessed using statistical process control. Learning outcomes were assessed with the Quality Improvement Knowledge Application Tool-Revised (QIKAT-R) and through self-efficacy, interprofessional care attitudes, and satisfaction of learners. Free text responses by residents and a focus group of nurses who worked with the residents provided information about the acceptability of the intervention. The QI projects improved many clinical processes and outcomes, but not all led to improvements. Educational outcome response rates were 65% (68 of 105) at baseline, 50% (18 of 36) for the early intervention group at midpoint, 67% (24 of 36) for the control group at midpoint, and 53% (42 of 80) for the late intervention group. Composite QIKAT-R scores (range, 0-27) increased from 13.3 at baseline to 15.3 at end point ( P  < .01), as did the self-efficacy composite score ( P  < .05). Satisfaction with the curriculum was rated highly by all participants. Learning and participating in hands-on QI can be integrated into the usual inpatient work of resident physicians.

Burnout syndrome during residency in internal medicine and pediatrics in a country without working time directive.

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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.

Psychometric Properties of the Thai Internalized Stigma Scale (TIS-LCH) for Care Home Residents.

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Tosangwarn, Suhathai; Clissett, Philip; Blake, Holly

2017-01-01

Living in a care home is a source of stigma in Thai culture, although there is currently no measurement tool in the Thai language specifically designed to assess internalized stigma in care home residents. The Thai Version of Internalized Stigma of Living in a Care Home (TIS-LCH) scale was developed and tested for its psychometric properties among Thai older residents. The Thai version of Internalized Stigma of Mental Health Illness (ISMI) Scale was revised into the TIS-LCH by replacing the word of "mental health illness" to "living in a care home." Content validity of the TIS-LCH was determined through expert review (n = 6), and reliability testing was undertaken with older care home residents (n = 128). The TIS-LCH showed good internal consistency, with a Cronbach's alpha of .87. Test-retest reliability coefficient of TIS-LCH was excellent for the full scale (ICC = .90). The Thai version of IS-LCH (TIS-LCH) is a valid and reliable measurement tool for assessing internalized stigma in Thai care home residents. The IS-LCH will be a useful research tool to assess internalized stigma in older adults living in care settings. Understanding stigma will help health and social care professionals to plan interventions aimed at reducing or preventing negative emotional reactions and negative behavioural responses toward stigma, which are known to be associated with mental illness and particularly depression among this population.

Relationship between internal medicine program board examination pass rates, accreditation standards, and program size.

Science.gov (United States)

Falcone, John L; Gonzalo, Jed D

2014-01-19

To determine Internal Medicine residency program compliance with the Accreditation Council for Graduate Medical Education 80% pass-rate standard and the correlation between residency program size and performance on the American Board of Internal Medicine Certifying Examination. Using a cross-sectional study design from 2010-2012 American Board of Internal Medicine Certifying Examination data of all Internal Medicine residency pro-grams, comparisons were made between program pass rates to the Accreditation Council for Graduate Medical Education pass-rate standard. To assess the correlation between program size and performance, a Spearman's rho was calculated. To evaluate program size and its relationship to the pass-rate standard, receiver operative characteristic curves were calculated. Of 372 Internal Medicine residency programs, 276 programs (74%) achieved a pass rate of =80%, surpassing the Accreditation Council for Graduate Medical Education minimum standard. A weak correlation was found between residency program size and pass rate for the three-year period (p=0.19, pInternal Medicine residency programs complied with Accreditation Council for Graduate Medical Education pass-rate standards, a quarter of the programs failed to meet this requirement. Program size is positively but weakly associated with American Board of Internal Medicine Certifying Examination performance, suggesting other unidentified variables significantly contribute to program performance.

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.

Perspectives of interns and residents toward do-not-resuscitate policies in Saudi Arabia

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Amoudi AS

2016-03-01

Full Text Available Abdullah S Amoudi,1 Mohammed H Albar,2 Amjed M Bokhari,3 Sultan H Yahya,4 Anas A Merdad1 1Department of Internal Medicine, 2Department of Obstetrics and Gynecology, 3Department of Surgery, King Abdulaziz University Hospital, Jeddah, 4Department of Radiology, King Saud University Hospital, Riyadh, Kingdom of Saudi Arabia Objective: Do-not-resuscitate (DNR orders in Saudi Arabia were first regulated by a fatwa on a national level in 1988, one that excludes the patient and their families from decision making. Although the core of this policy is taken up by all hospitals in Saudi Arabia, there is no homogeneity in implementation. Here, we appraise what interns and residents know of these policies and their attitudes toward DNR. Methods: Interns and residents in four major hospitals in Jeddah, King Abdulaziz University Hospital, National Guard Hospital, King Fahad General Hospital, and King Fahad Armed Forces Hospital, were given a questionnaire in English with four blocks of questions. Results: A total of 140 questionnaires were included in our study. From these questionnaires, we conclude a lack of familiarity with DNR's policies and the fatwa and also a lack of understanding when it comes to treating DNR-labeled patients. The majority opinion was to include the patient in the decision-making process who is excluded according to the fatwa. Participants considered patients' dignity, religious concerns, and legal concerns to be important in considering resuscitation. Conclusion: We conclude a need to emphasize the issue of DNR and treatment of DNR patients in medical ethics classes in Saudi Arabia and put more effort to enact national DNR laws that include the patient in the decision-making process. Keywords: passive euthanasia, Middle East, cross-sectional study

Professionalism, professionalization, expertise and compassion: a qualitative study of medical residents.

Science.gov (United States)

Phillips, Susan P; Dalgarno, Nancy

2017-01-23

Formal and informal medical curricula convey expectations about professionalization, that is, the development of physician identity, and also about professionalism. This study examined whether, in general, junior residents experienced any dissonance between these roles and focused particularly on how they negotiated conflicts between compassion, self-care, duty and medical expertise. In 2015, purposive sampling was used to select 21 first-year residents at a Canadian medical school. Participants listened to a 5-min audio-recording narrated in either male or female voice. Facing compassion fatigue after three obstetrical disasters over less than 2 days the resident narrator asks to go home. Participants reacted in writing to questions about this request and relevant teaching/modelling. Responses were analyzed using a qualitative, exploratory, thematic research design. Four themes were identified: i) empathy, self-doubt and fear of weakness, ii) the need for support from and communication with physicians and others, iii) education received, and iv) professionalization outranks professionalism. Participants agreed that under the circumstances the narrator's care, compassion and request were appropriate. Never the less, many grappled with feeling that asking to be relieved of work demonstrated weakness and a shirking of responsibility. Respondents had received no formal teaching about balancing compassion for patients or self with professional duty. Preceptors' informal teaching and modeling valorized scientific disengagement above all else. What emerged was participants' drive to become detached clinicians who set aside emotional responses and interactions that could impede and be incompatible with professionalization. However, participants also recognized and lamented what was lost in such a transformation. In the transition from student to practitioner, trainees' views and the modeling they receive shift emotion and compassion, whether for self or patients, from

Toward a Resident Personal Finance Curriculum: Quantifying Resident Financial Circumstances, Needs, and Interests.

Science.gov (United States)

McKillip, Ryan; Ernst, Michael; Ahn, James; Tekian, Ara; Shappell, Eric

2018-04-26

Introduction Resident financial health has been linked to wellness and resiliency, yet financial literacy among residents is highly variable. While some medical school curricula include budgeting and student loan education, content on managing finances as a resident is usually lacking. We sought to quantitatively assess residents' financial circumstances, needs, and interests to inform the design of a resident personal finance curriculum. Methods Surveys were sent to residents in eight specialties at an academic medical center. Likert-type responses allowed respondents to rate their level of comfort (1 = Very Uncomfortable, 7 = Very Comfortable) and interest (1 = Very Uninterested, 7 = Very Interested) in various personal finance topics including budgeting, loan repayment, disability insurance, life insurance, home buying, and retirement planning. Details regarding financial circumstances, including assets, liabilities, and insurance, were also collected. Results of questions that utilized a Likert-type scale are reported as median (interquartile range). Results Of 346 residents surveyed, 144 (41.6%) responded. Residents were from Internal Medicine (56, 38.9%), Pediatrics (34, 23.6%), Emergency Medicine (18, 12.5%), and other specialties (36, 25.0%). Ninety-one (63.2%) reported educational loans, with an average balance of $191,730. Credit card balances exceeding $3,000 were reported by 11 (7.6%) respondents. One-hundred-two (70.1%) reported emergency savings, but only 65 (45.1%) reported having a retirement account (average balance $27,608). Respondents rated highest comfort levels with budgeting (5[4-6]), and lowest level of comfort with disability insurance (2[2-4]) and home buying (2[2-5]). Interest in learning each topic was high (6[5-7]), with retirement planning (6[5-7]), investing (6[5-7]), and home buying (6[5-7]) the topics of highest interest. Conclusion These results highlight the deficits in personal finance literacy among residents. Future work should

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

Analysis of Work Assignments After Medical Ethics Workshop for First-Year Residents at Siriraj Hospital

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Sakda Sathirareuangchai

2016-11-01

Full Text Available Background: Upon entering the residency training program, all 1st year residents at Siriraj Hospital must join medical ethics workshop held by the Division of Postgraduate Studies. At the end of the workshop, the residents were given a work assignment to write a clinical ethics situation they have encountered in their past practice. Methods: This study is an analysis of content described in the work assignments in order to gain the information regarding common medical ethics dilemmas, which the physicians faced in the early days of practice. Results: 740 work assignments were reviewed. The 4 most common ethical principle mentioned in these assign- ments were autonomy (144, 19.5%, palliative care (133, 18.0%, beneficence (121, 16.4%, and confidentiality (110, 14.9%. More than half of the situations described were during their internship (474, 64.1% and tended to distributed equally among community hospital (39.1%, university hospital (28.0%, and general hospital (24.3%. Conclusion: This study should raise the awareness of the medical educator towards these medical ethics issues during curriculum planning.

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.

Interrelationships between romance, life quality, and medical training of female residents

Directory of Open Access Journals (Sweden)

Yu-Jung Wang

2012-08-01

Conclusion: Romance and quality of 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.

SU-E-E-03: Shared Space Fosters Didactic and Professional Learning Across Professions for Medical and Physics Residents

International Nuclear Information System (INIS)

Dieterich, S; Perks, J; Fragoso, R

2015-01-01

Purpose: Medical Physicists and Radiation Oncologists are two professions who should be working as a team for optimal patient care, yet lack of mutual understanding about each others respective role and work environment creates barriers To improve collaboration and learning, we designed a shared didactic and work space for physics and radiation oncology residents to maximize interaction throughout their professional training. Methods: Physician and Physics residents are required to take the same didactic classes, including journal clubs and respective seminars. The residents also share an office environment among the seven physician and two physic residents. Results: By maximizing didactic overlap and sharing office space, the two resident groups have developed a close professional relationship and supportive work environment. Several joint research projects have been initiated by the residents. Awareness of physics tasks in the clinic has led to a request by the physician residents to change physics didactics, converting the physics short course into a lab-oriented course for the medical residents which is in part taught by the physics residents. The physics seminar is given by both residency groups; increased motivation and interest in learning about physics has led to several medical resident-initiated topic selections which generated lively discussion. The physics long course has changed toward including more discussion among residents to delve deeper into topics and study beyond what passing the boards would require. A supportive work environment has developed, embedding the two physics residents into a larger residents group, allowing them to find mentor and peers more easily. Conclusion: By creating a shared work and didactic environment, physician and physics residents have improved their understanding of respective professional practice. Resident-initiated changes in didactic practice have led to improved learning and joint research. A strong social

SU-E-E-03: Shared Space Fosters Didactic and Professional Learning Across Professions for Medical and Physics Residents

Energy Technology Data Exchange (ETDEWEB)

Dieterich, S; Perks, J; Fragoso, R [UC Davis Medical Center, Sacramento, CA (United States)

2015-06-15

Purpose: Medical Physicists and Radiation Oncologists are two professions who should be working as a team for optimal patient care, yet lack of mutual understanding about each others respective role and work environment creates barriers To improve collaboration and learning, we designed a shared didactic and work space for physics and radiation oncology residents to maximize interaction throughout their professional training. Methods: Physician and Physics residents are required to take the same didactic classes, including journal clubs and respective seminars. The residents also share an office environment among the seven physician and two physic residents. Results: By maximizing didactic overlap and sharing office space, the two resident groups have developed a close professional relationship and supportive work environment. Several joint research projects have been initiated by the residents. Awareness of physics tasks in the clinic has led to a request by the physician residents to change physics didactics, converting the physics short course into a lab-oriented course for the medical residents which is in part taught by the physics residents. The physics seminar is given by both residency groups; increased motivation and interest in learning about physics has led to several medical resident-initiated topic selections which generated lively discussion. The physics long course has changed toward including more discussion among residents to delve deeper into topics and study beyond what passing the boards would require. A supportive work environment has developed, embedding the two physics residents into a larger residents group, allowing them to find mentor and peers more easily. Conclusion: By creating a shared work and didactic environment, physician and physics residents have improved their understanding of respective professional practice. Resident-initiated changes in didactic practice have led to improved learning and joint research. A strong social

Internal and external radiation exposures of Fukushima residents

International Nuclear Information System (INIS)

Hayano, Ryugo

2014-01-01

The soil at Fukushima prefecture and its outskirts was heavily contaminated with radioactive materials from the troubled Fukushima Daiichi nuclear power plant, and the residents suffered risk from internal and external radiation exposure. At first, the average dose of internal radiation exposure was estimated to be several mSv based upon the results of Chernobyl nuclear disaster. But the result of massive measurements using whole body counters shows that the average quantity of internal radioactive cesium is less than that at the Cold Water period. In the meantime, someone shows exposure dose much higher than the average. The distribution of these abnormal doses is called 'Long Tail'. One must pay attention to the long tail at the assessment of the internal radiation exposure by Fukushima nuclear disaster. The main origin of the long tail is related to frequency eating of special food. It is thus important to find persons situated in the long tail and give them guidance on the meals. (J.P.N.)

Enacting the Carnegie Foundation call for reform of medical school and residency.

Science.gov (United States)

O'Brien, Bridget C; Irby, David M

2013-01-01

On the 100th anniversary of the Flexner Report, the Carnegie Foundation for the Advancement of Teaching published a new study of medical education. This study, titled Educating Physicians: A Call for Reform of Medical Schools and Residency Programs, contained four primary recommendations intended to stimulate innovation and improvement in medical education. In this article, the authors examined the ways others have applied the four recommendations from Educating Physicians within and beyond medical education. In their review of 246 publications citing the Carnegie work, they found that the recommendation for integration was addressed most frequently, often through descriptions of integration of curricular content in undergraduate medical education. The recommendation to focus on professional identity formation was the second most frequently addressed, followed by standardization and individualization, then inquiry, innovation, and improvement. The publications related to these latter three recommendations tended to be conceptual rather than descriptive or empirical. Publications spanned the continuum of medical education (from medical school to residency to physicians in practice) and even into other fields, but undergraduate medical education received the most attention. The authors discuss common themes among the citing publications and highlight opportunities for further discussion and innovation. Many exciting developments have occurred in medical education and beyond since the publication of Educating Physicians in 2010. Thus far, most of the publications citing the Carnegie recommendations describe incremental changes in medical education, particularly in the area of integration. Some of the conceptual work around these recommendations, coupled with a variety of external factors such as changes in health care and accreditation systems, suggests the potential for changes that are more transformative in nature.

Development of a Quality and Safety Competency Curriculum for Radiation Oncology Residency: An International Delphi Study

International Nuclear Information System (INIS)

Adleman, Jenna; Gillan, Caitlin; Caissie, Amanda; Davis, Carol-Anne; Liszewski, Brian; McNiven, Andrea; Giuliani, Meredith

2017-01-01

Purpose: To develop an entry-to-practice quality and safety competency profile for radiation oncology residency. Methods and Materials: A comprehensive list of potential quality and safety competency items was generated from public and professional resources and interprofessional focus groups. Redundant or out-of-scope items were eliminated through investigator consensus. Remaining items were subjected to an international 2-round modified Delphi process involving experts in radiation oncology, radiation therapy, and medical physics. During Round 1, each item was scored independently on a 9-point Likert scale indicating appropriateness for inclusion in the competency profile. Items indistinctly ranked for inclusion or exclusion were re-evaluated through web conference discussion and reranked in Round 2. Results: An initial 1211 items were compiled from 32 international sources and distilled to 105 unique potential quality and safety competency items. Fifteen of the 50 invited experts participated in round 1: 10 radiation oncologists, 4 radiation therapists, and 1 medical physicist from 13 centers in 5 countries. Round 1 rankings resulted in 80 items included, 1 item excluded, and 24 items indeterminate. Two areas emerged more prominently within the latter group: change management and human factors. Web conference with 5 participants resulted in 9 of these 24 items edited for content or clarity. In Round 2, 12 participants rescored all indeterminate items resulting in 10 items ranked for inclusion. The final 90 enabling competency items were organized into thematic groups consisting of 18 key competencies under headings adapted from Deming's System of Profound Knowledge. Conclusions: This quality and safety competency profile may inform minimum training standards for radiation oncology residency programs.

Development of a Quality and Safety Competency Curriculum for Radiation Oncology Residency: An International Delphi Study

Energy Technology Data Exchange (ETDEWEB)

Adleman, Jenna [Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Gillan, Caitlin [Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Caissie, Amanda [Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia (Canada); Saint John Regional Hospital, Saint John, New Brunswick (Canada); Davis, Carol-Anne [Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia (Canada); Nova Scotia Cancer Centre, Halifax, Nova Scotia (Canada); Liszewski, Brian [Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario (Canada); McNiven, Andrea [Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Giuliani, Meredith, E-mail: Meredith.Giuliani@rmp.uhn.ca [Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada)

2017-06-01

Purpose: To develop an entry-to-practice quality and safety competency profile for radiation oncology residency. Methods and Materials: A comprehensive list of potential quality and safety competency items was generated from public and professional resources and interprofessional focus groups. Redundant or out-of-scope items were eliminated through investigator consensus. Remaining items were subjected to an international 2-round modified Delphi process involving experts in radiation oncology, radiation therapy, and medical physics. During Round 1, each item was scored independently on a 9-point Likert scale indicating appropriateness for inclusion in the competency profile. Items indistinctly ranked for inclusion or exclusion were re-evaluated through web conference discussion and reranked in Round 2. Results: An initial 1211 items were compiled from 32 international sources and distilled to 105 unique potential quality and safety competency items. Fifteen of the 50 invited experts participated in round 1: 10 radiation oncologists, 4 radiation therapists, and 1 medical physicist from 13 centers in 5 countries. Round 1 rankings resulted in 80 items included, 1 item excluded, and 24 items indeterminate. Two areas emerged more prominently within the latter group: change management and human factors. Web conference with 5 participants resulted in 9 of these 24 items edited for content or clarity. In Round 2, 12 participants rescored all indeterminate items resulting in 10 items ranked for inclusion. The final 90 enabling competency items were organized into thematic groups consisting of 18 key competencies under headings adapted from Deming's System of Profound Knowledge. Conclusions: This quality and safety competency profile may inform minimum training standards for radiation oncology residency programs.

International collaboration in medical radiation science.

Science.gov (United States)

Denham, Gary; Allen, Carla; Platt, Jane

2016-06-01

International collaboration is recognised for enhancing the ability to approach complex problems from a variety of perspectives, increasing development of a wider range of research skills and techniques and improving publication and acceptance rates. The aim of this paper is to describe the current status of international collaboration in medical radiation science and compare this to other allied health occupations. This study utilised a content analysis approach where co-authorship of a journal article was used as a proxy for research collaboration and the papers were assigned to countries based on the corporate address given in the by-line of the publication. A convenience sample method was employed and articles published in the professional medical radiation science journals in the countries represented within our research team - Australia, the United Kingdom (UK) and the United States of America (USA) were sampled. Physiotherapy, speech pathology, occupational therapy and nursing were chosen for comparison. Rates of international collaboration in medical radiation science journals from Australia, the UK and the USA have steadily increased over the 3-year period sampled. Medical radiation science demonstrated lower average rates of international collaboration than the other allied health occupations sampled. The average rate of international collaboration in nursing was far below that of the allied health occupations sampled. Overall, the UK had the highest average rate of international collaboration, followed by Australia and the USA, the lowest. Overall, medical radiation science is lagging in international collaboration in comparison to other allied health fields.

Administrative Cicular No. 31 (Rev. 2) - International indemnity and non-resident allowance

CERN Multimedia

Department Head Office - HR Department

2016-01-01

Administrative Circular No. 31 (Rev. 2) entitled "International indemnity and non-resident allowance", approved by the Director-General following discussion in the Standing Concertation Committee meeting on 23 June 2016, will be available on 1st September 2016 via the following link: https://cds.cern.ch/record/2208547.   This revised circular cancels and replaces Administrative Circular No. 31 (Rev. 1) also entitled "International indemnity and non-resident allowance" of October 2007. The main changes reflect the decision taken in the framework of the five-yearly review to extend eligibility for international indemnity to all staff members, as well to introduce a distinction between current staff members and those recruited as from 1st September 2016. For the latter, the international indemnity will be calculated as a percentage of the minimum salary of the grade into which they are recruited; the amount granted to the former will not change, and is now expressed ...

Emotional Burnout, Perceived Sources of Job Stress, Professional Fulfillment, and Engagement among Medical Residents in Malaysia

OpenAIRE

Al-Dubai, Sami Abdo Radman; Ganasegeran, Kurubaran; Perianayagam, Wilson; Rampal, Krishna Gopal

2013-01-01

This study was the first to explore factors associated with emotional burnout (EB) among medical residents in Malaysia. A cross-sectional study was conducted in a universal sample of 205 medical residents in a Malaysian general hospital. The self-administered questionnaire used consisted of questions on sociodemographics and work characteristics, sources of job stress, professional fulfillment, engagement, and EB. EB was measured using the emotional exhaustion subscale, the Maslach Burnout In...

[Selection of medical graduates for residency posts. A comparative study of the methodologies used in different countries].

Science.gov (United States)

Lobato, Ramiro D; Lagares, Alfonso; Villena, Victoria; García Seoane, Jorge; Jiménez-Roldán, Luis; Munarriz, Pablo M; Castaño-Leon, Ana M; Alén, José F

2015-01-01

The design of an appropriate method for the selection of medical graduates for residency posts is extremely important, not only for the efficiency of the method itself (accurate identification of most competent candidates), but also for its influence on the study and teaching methodologies operating in medical schools. Currently, there is a great variation in the criteria used in different countries and there is no definitively appropriate method. The use of isolated or combined criteria, such as the marks obtained by students in medical schools, their performance in tests of theoretical knowledge and evaluations of clinical competence, or personal interviews, have a limited value for identifying those candidates who will perform better during the residency and later on during independent practice. To analyse the variability in the methodologies used for the selection of residents employed in different countries, in particular those used in the United Kingdom and USA, where external agencies and medical schools make systematic analyses of curriculum development. The advantages and disadvantages of national or transnational licensing examinations on the process of convergence and harmonization of medical degrees and residency programmes through Europe are discussed. The present analysis is used to design a new and more efficient multi-criteria methodology for resident selection in Spain, which will be published in the next issue of this journal. Since the multi-criteria methods used in UK and USA appear to be most consistent, these have been employed for designing the new methodology that could be applied in Spain. Although many experts in medical education reject national examinations for awarding medical degrees or ranking candidates for residency posts, it seems that, when appropriately designed, they can be used to verify the level of competence of graduating students without necessarily distorting curriculum implementation or improvement. Copyright © 2014

Demand for voluntary basic medical insurance in urban China: panel evidence from the Urban Resident Basic Medical Insurance scheme.

Science.gov (United States)

Chen, Gang; Yan, Xiao

2012-12-01

This paper investigates the key factors associated with the demand for Urban Resident Basic Medical Insurance (URBMI), which was established in 2007 and aims to cover all Chinese urban residents. Two waves of longitudinal household survey data are used, and a three-level random-intercept logit model is used for the analysis. Two different sets of explanatory variables were identified for adults and children, separately. Results suggest for both the adult and the child samples that income, health status, age and health risk behaviours are key influencing factors for basic medical insurance demand. The household head's characteristics are also significantly related to other household members' medical insurance demands. Specifically, household heads who are more educated or retired are more likely to purchase medical insurance for their children. These findings suggest that an expansion of the special subsidy to the poor or, probably more important, a risk-adjusted benefit package may be needed for voluntary basic medical insurance in China. In addition, adverse selection consistently exists and is a major challenge for the sustainability of medical insurance financing. To expand insurance coverage for children, especially those under school age, special efforts (possibly through health education or health promotion) should be focused on the household head, particularly those engaging in risky health behaviours.

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

Andragogy and medical education: are medical students internally motivated to learn?

Science.gov (United States)

Misch, Donald A

2002-01-01

Andragogy - the study of adult education - has been endorsed by many medical educators throughout North America. There remains, however, considerable controversy as to the validity and utility of adult education principles as espoused by the field's founder, Malcolm Knowles. Whatever the utility of andragogic doctrine in general education settings, there is reason to doubt its wholesale applicability to the training of medical professionals. Malcolm Knowles' last tenet of andragogy holds that adult learners are more motivated by internal than by external factors. The validity of this hypothesis in medical education is examined, and it is demonstrated that medical students' internal and external motivation are context-dependent, not easily distinguishable, and interrelate with one another in complex ways. Furthermore, the psychological motivation for medical student learning is determined by a variety of factors that range from internal to external, unconscious to conscious, and individual to societal. The andragogic hypothesis of increased internal motivation to learn on the part of adults in general, and medical trainees in particular, is rejected as simplistic, misleading, and counterproductive to developing a greater understanding of the forces that drive medical students to learn.

Awareness about medical research among resident doctors in a tertiary care hospital: A cross-sectional survey

Directory of Open Access Journals (Sweden)

Dattatray B Pawar

2012-01-01

Full Text Available Context: Every medical practitioner should strive to contribute to the generation of evidence by conducting research. For carrying out research, adequate knowledge, practical skills, and development of the right attitude are crucial. A literature review shows that data regarding knowledge, attitude, and practices toward medical research, among resident doctors in India, is lacking. Aims: This study was conducted to assess research-related knowledge, attitude, and practices among resident doctors. Settings and Design: A cross-sectional survey was conducted using a pretested, structured, and pre-validated questionnaire. Materials and Methods: With approval of the Institutional Ethics Committee and a verbal consent, a cross-sectional survey among 100 resident doctors pursuing their second and third years in the MD and MS courses was conducted using a structured and pre-validated questionnaire. Statistical Analysis: Descriptive statistics were used to analyze the results. Results: The concept of research hypothesis was known to 58% of the residents. Ninety-eight percent of the residents were aware of the procedure to obtain informed consent. Seventy-six percent agreed that research training should be mandatory. Although 88% of the residents were interested in conducting research in future, 50% had participated in research other than a dissertation project, 28% had made scientific presentations, and only 4% had publications. Lack of time (74%, lack of research curriculum (42%, and inadequate facilities (38% were stated as major obstacles for pursuing research. Conclusions: Although resident doctors demonstrated a fairly good knowledge and positive attitude toward research, it did not translate into practice for most of them. There is a need to improve the existing medical education system to foster research culture among resident doctors

Outcomes of an Advanced Ultrasound Elective: Preparing Medical Students for Residency and Practice.

Science.gov (United States)

Prats, Michael I; Royall, Nelson A; Panchal, Ashish R; Way, David P; Bahner, David P

2016-05-01

Many medical specialties have adopted the use of ultrasound, creating demands for higher-quality ultrasound training at all levels of medical education. Little is known about the long-term benefit of integrating ultrasound training during undergraduate medical education. This study evaluated the effect of a longitudinal fourth-year undergraduate medical education elective in ultrasound and its impact on the future use of ultrasound in clinical practice. A cross-sectional survey of medical graduates from The Ohio State University College of Medicine (2006-2011) was done, comparing those who participated and those who did not participate in a rigorous ultrasound program for fourth-year medical students. A 38-item questionnaire queried graduates concerning ultrasound education in residency, their proficiency, and their current use of ultrasound in clinical practice. Surveys were completed by 116 respondents, for a return rate of 40.8% (116 of 284). The participants of the undergraduate medical education ultrasound elective (n = 61) reported more hours of ultrasound training after graduation (hands-on training, bedside scanning, and number of scans performed; P practice (P medical education ultrasound elective produced physicians who were more likely to seek additional training in residency, evaluate themselves as more proficient, and use ultrasound in their clinical practice. Early training in bedside ultrasound during undergraduate medical education yields physicians who are better prepared for integration of ultrasound into clinical practice. © 2016 by the American Institute of Ultrasound in Medicine.

Program Characteristics Influencing Allopathic Students' Residency Selection.

Science.gov (United States)

Stillman, Michael D; Miller, Karen Hughes; Ziegler, Craig H; Upadhyay, Ashish; Mitchell, Charlene K

2016-04-01

Medical students must consider many overt variables when entering the National Resident Matching Program. However, changes with the single graduate medical education accreditation system have caused a gap in knowledge about more subtle considerations, including what, if any, influence the presence of osteopathic physician (ie, DO) and international medical graduate (IMG) house officers has on allopathic students' residency program preferences. Program directors and selection committee members may assume students' implicit bias without substantiating evidence. To reexamine which program characteristics affect US-trained allopathic medical students' residency selection, and to determine whether the presence of DO and IMG house officers affects the program choices of allopathic medical students. Fourth-year medical students from 4 allopathic medical schools completed an online survey. The Pearson χ(2) statistic was used to compare demographic and program-specific traits that influence ranking decisions and to determine whether school type (private vs public), valuing a residency program's prestige, or interest in a competitive specialty dictated results. Qualitative data were analyzed using the Pandit variation of the Glaser and Strauss constant comparison. Surveys were completed by 323 of 577 students (56%). Students from private vs public institutions were more likely to value a program's prestige (160 [93%] vs 99 [72%]; P<.001) and research opportunities (114 [66%] vs 57 [42%]; P<.001), and they were less likely to consider their prospects of being accepted (98 [57%] vs 111 [81%]; P<.001). A total of 33 (10%) and 52 (16%) students reported that the presence of DO or IMG trainees, respectively, would influence their final residency selection, and these percentages were largely unchanged among students interested in programs' prestige or in entering a competitive specialty. Open-ended comments were generally optimistic about diversification of the physician

Competency-based residency training and the web log: modeling practice-based learning and enhancing medical knowledge

Directory of Open Access Journals (Sweden)

Matthew F. Hollon

2015-12-01

Full Text Available Background: By using web-based tools in medical education, there are opportunities to innovatively teach important principles from the general competencies of graduate medical education. Objectives: Postulating that faculty transparency in learning from uncertainties in clinical work could help residents to incorporate the principles of practice-based learning and improvement (PBLI in their professional development, faculty in this community-based residency program modeled the steps of PBLI on a weekly basis through the use of a web log. Method: The program confidentially surveyed residents before and after this project about actions consistent with PBLI and knowledge acquired through reading the web log. Results: The frequency that residents encountered clinical situations where they felt uncertain declined over the course of the 24 weeks of the project from a mean frequency of uncertainty of 36% to 28% (Wilcoxon signed rank test, p=0.008; however, the frequency with which residents sought answers when faced with uncertainty did not change (Wilcoxon signed rank test, p=0.39, remaining high at approximately 80%. Residents answered a mean of 52% of knowledge questions correct when tested prior to faculty posts to the blog, rising to a mean of 65% of questions correct when tested at the end of the project (paired t-test, p=0.001. Conclusions: Faculty role modeling of PBLI behaviors and posting clinical questions and answers to a web log led to modest improvements in medical knowledge but did not alter behavior that was already taking place frequently among residents.

Teaching Medical Ethics in Graduate and Undergraduate Medical Education: A Systematic Review of Effectiveness.

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de la Garza, Santiago; Phuoc, Vania; Throneberry, Steven; Blumenthal-Barby, Jennifer; McCullough, Laurence; Coverdale, John

2017-08-01

One objective was to identify and review studies on teaching medical ethics to psychiatry residents. In order to gain insights from other disciplines that have published research in this area, a second objective was to identify and review studies on teaching medical ethics to residents across all other specialties of training and on teaching medical students. PubMed, EMBASE, and PsycINFO were searched for controlled trials on teaching medical ethics with quantitative outcomes. Search terms included ethics, bioethics, medical ethics, medical students, residents/registrars, teaching, education, outcomes, and controlled trials. Nine studies were found that met inclusion criteria, including five randomized controlled trails and four controlled non-randomized trials. Subjects included medical students (5 studies), surgical residents (2 studies), internal medicine house officers (1 study), and family medicine preceptors and their medical students (1 study). Teaching methods, course content, and outcome measures varied considerably across studies. Common methodological issues included a lack of concealment of allocation, a lack of blinding, and generally low numbers of subjects as learners. One randomized controlled trial which taught surgical residents using a standardized patient was judged to be especially methodologically rigorous. None of the trials incorporated psychiatry residents. Ethics educators should undertake additional rigorously controlled trials in order to secure a strong evidence base for the design of medical ethics curricula. Psychiatry ethics educators can also benefit from the findings of trials in other disciplines and in undergraduate medical education.

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/.

Securing an OTL-HNS residency: how competitive is it? Comparing medical student perceptions to actual Canadian statistics.

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Kay-Rivest, E; Varma, N; Scott, G M; Manoukian, J J; Desrosiers, M; Vaccani, J P; Nguyen, L H P

2017-02-27

The residency match is an important event in an aspiring physician's career. Otolaryngology - Head and Neck Surgery (OTL-HNS) is a surgical specialty that has enjoyed high numbers of applicants to its residency programs. However, recent trends in Canada show a decline in first-choice applicants to several surgical fields. Factors thought to influence a medical student's choice include role models, career opportunities and work-life balance. The notion of perceived competitiveness is a factor that has not yet been explored. This study sought to compare competitiveness of OTL-HNS, as perceived by Canadian medical students to residency match statistics published yearly by CaRMS (Canadian Residency Matching Service), with the hope of informing future decisions of surgical residency programs. An electronic survey was created and distributed to all medical students enrolled in the 17 Canadian medical schools. After gathering demographic information, students were asked to rank what they perceived to be the five most competitive disciplines offered by CaRMS. They were also asked to rank surgical specialties from most to least competitive. Publically available data from CaRMS was then collected and analyzed to determine actual competitiveness of admissions to Canadian OTL-HNS residency programs. 1194 students, from first to fourth year of medical school, completed the survey. CaRMS statistics over the period from 2008 to 2014 demonstrated that the five most competitive specialties were Plastic Surgery, Dermatology, Ophthalmology, Emergency Medicine and OTL-HNS. Among surgical disciplines, OTL-HNS was third most competitive, where on average 72% of students match to their first-choice discipline. When students were questioned, 35% ranked OTL-HNS amongst the top five most competitive. On the other hand 72%, 74% and 80% recognized Opthalmology, Dermatology and Plastic Surgery as being among the five most competitive, respectively. We found that fourth-year medical students

Delegation of medical tasks in French radiation oncology departments: current situation and impact on residents' training.

Science.gov (United States)

Thureau, S; Challand, T; Bibault, J-E; Biau, J; Cervellera, M; Diaz, O; Faivre, J-C; Fumagalli, I; Leroy, T; Lescut, N; Martin, V; Pichon, B; Riou, O; Dubray, B; Giraud, P; Hennequin, C

2013-10-01

A national survey was conducted among the radiation oncology residents about their clinical activities and responsibilities. The aim was to evaluate the clinical workload and to assess how medical tasks are delegated and supervised. A first questionnaire was administered to radiation oncology residents during a national course. A second questionnaire was mailed to 59 heads of departments. The response rate was 62% for radiation oncology residents (99 questionnaires) and 51% for heads of department (30). Eighteen heads of department (64%) declared having written specifications describing the residents' clinical tasks and roles, while only 31 radiation oncology residents (34%) knew about such a document (P=0.009). A majority of residents were satisfied with the amount of medical tasks that were delegated to them. Older residents complained about insufficient exposure to new patient's consultation, treatment planning and portal images validation. The variations observed between departments may induce heterogeneous trainings and should be addressed specifically. National specifications are necessary to reduce heterogeneities in training, and to insure that the residents' training covers all the professional skills required to practice radiation oncology. A frame endorsed by academic and professional societies would also clarify the responsibilities of both residents and seniors. Copyright © 2013 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

A survey of primary care resident attitudes toward continuity clinic patient handover

Directory of Open Access Journals (Sweden)

Victor O. Kolade

2014-11-01

Full Text Available Background: Transfer of clinic patients from graduating residents to interns or junior residents occurs every year, affecting large numbers of patients. Breaches in care continuity may occur, with potential for risk to patient safety. Several guidelines have been developed for implementing standardized inpatient sign-outs, but no specific guidelines exist for outpatient handover. Methods: Residents in primary care programs – internal medicine, family medicine, and pediatrics – at a US academic medical center were invited to participate in an online survey. The invitation was extended approximately 2 years after electronic medical record (EMR rollout began at the institution. Results: Of 71 eligible residents, 22 (31% responded to the survey. Of these, 18 felt that handover of ambulatory patients was at least moderately important – but only one affirmed the existence of a system for handover. IM residents perceived that they had the highest proportion of high-risk patients (p=0.042; transition-of-care letters were more important to IM residents than other respondents (p=0.041. Conclusion: There is room for improvement in resident acknowledgement of handover processes in continuity clinics. In this study, IM residents attached greater importance to a specific handover tool than other primary care residents. Thus, the different primary care specialties may need to have different handover tools available to them within a shared EMR system.

Incorporating resident research into the dermatology residency program

Science.gov (United States)

Wagner, Richard F; Raimer, Sharon S; Kelly, Brent C

2013-01-01

Programmatic changes for the dermatology residency program at The University of Texas Medical Branch were first introduced in 2005, with the faculty goal incorporating formal dermatology research projects into the 3-year postgraduate training period. This curriculum initially developed as a recommendation for voluntary scholarly project activity by residents, but it evolved into a program requirement for all residents in 2009. Departmental support for this activity includes assignment of a faculty mentor with similar interest about the research topic, financial support from the department for needed supplies, materials, and statistical consultation with the Office of Biostatistics for study design and data analysis, a 2-week elective that provides protected time from clinical activities for the purpose of preparing research for publication and submission to a peer-reviewed medical journal, and a departmental award in recognition for the best resident scholarly project each year. Since the inception of this program, five classes have graduated a total of 16 residents. Ten residents submitted their research studies for peer review and published their scholarly projects in seven dermatology journals through the current academic year. These articles included three prospective investigations, three surveys, one article related to dermatology education, one retrospective chart review, one case series, and one article about dermatopathology. An additional article from a 2012 graduate about dermatology education has also been submitted to a journal. This new program for residents was adapted from our historically successful Dermatology Honors Research Program for medical students at The University of Texas Medical Branch. Our experience with this academic initiative to promote dermatology research by residents is outlined. It is recommended that additional residency programs should consider adopting similar research programs to enrich resident education. PMID:23901305

Incorporating resident research into the dermatology residency program.

Science.gov (United States)

Wagner, Richard F; Raimer, Sharon S; Kelly, Brent C

2013-01-01

Programmatic changes for the dermatology residency program at The University of Texas Medical Branch were first introduced in 2005, with the faculty goal incorporating formal dermatology research projects into the 3-year postgraduate training period. This curriculum initially developed as a recommendation for voluntary scholarly project activity by residents, but it evolved into a program requirement for all residents in 2009. Departmental support for this activity includes assignment of a faculty mentor with similar interest about the research topic, financial support from the department for needed supplies, materials, and statistical consultation with the Office of Biostatistics for study design and data analysis, a 2-week elective that provides protected time from clinical activities for the purpose of preparing research for publication and submission to a peer-reviewed medical journal, and a departmental award in recognition for the best resident scholarly project each year. Since the inception of this program, five classes have graduated a total of 16 residents. Ten residents submitted their research studies for peer review and published their scholarly projects in seven dermatology journals through the current academic year. These articles included three prospective investigations, three surveys, one article related to dermatology education, one retrospective chart review, one case series, and one article about dermatopathology. An additional article from a 2012 graduate about dermatology education has also been submitted to a journal. This new program for residents was adapted from our historically successful Dermatology Honors Research Program for medical students at The University of Texas Medical Branch. Our experience with this academic initiative to promote dermatology research by residents is outlined. It is recommended that additional residency programs should consider adopting similar research programs to enrich resident education.

Changing Patterns of Glucose-Lowering Medication Use in VA Nursing Home Residents With Diabetes, 2005 to 2011.

Science.gov (United States)

Lee, Sei J; Stijacic-Cenzer, Irena; Barnhart, Caroline; McClymont, Keelan; Steinman, Michael A

2015-10-01

Although nursing home (NH) residents make up a large and growing proportion of Americans with diabetes mellitus, little is known about how glucose-lowering medications are used in this population. We sought to examine glucose-lowering medication use in Veterans Affairs (VA) NH residents with diabetes between 2005 and 2011. Retrospective cohort study, using linked laboratory, pharmacy, administrative, and NH Minimum Dataset (MDS) 2.0 databases in 123 VA NHs. A total of 9431 long-stay (>90 days) VA NH residents older than 65 followed for 52,313 person-quarters. We identified receipt of glucose-lowering medications, including insulin, metformin, sulfonylureas, thiazolidinediones, and others (alpha-glucosidase inhibitors, meglitinides, glucagonlike peptide-1 analogs, dipeptidyl peptidase-4 inhibitors and amylin analogs) per quarter. The rates of sulfonylurea use in long-stay NH residents dropped dramatically from 24% in 2005 to 12% in 2011 (P use (10% to 2%, P use in 2007 (4% to Metformin use was stable, ranging between 7% and 9% (P = .24). Insulin use increased slightly from 30% to 32% (P Use of other classes of glucose-lowering medications was stable (P = .22) and low, remaining below 1.3%. Between 2005 and 2011, there were dramatic declines in use of sulfonylureas and thiazolidinediones in VA NH residents, suggesting that prescribing practices can be quickly changed in this setting. Published by Elsevier Inc.

Irish medical students’ understanding of the intern year

LENUS (Irish Health Repository)

Gouda, P,

2016-03-01

Upon completion of medical school in Ireland, graduates must make the transition to becoming interns. The transition into the intern year may be described as challenging as graduates assume clinical responsibilities. Historically, a survey of interns in 1996 found that 91% felt unprepared for their role. However, recent surveys in 2012 have demonstrated that this is changing with preparedness rates reaching 52%. This can be partially explained by multiple initiatives at the local and national level. Our study aimed evaluate medical student understanding of the intern year and associated factors. An online, cross-sectional survey was sent out to all Irish medical students in 2013 and included questions regarding their understanding of the intern year. Two thousand, two hundred and forty-eight students responded, with 1224 (55.4%) of students agreeing or strongly agreeing that they had a good understanding of what the intern year entails. This rose to 485 (73.7%) among senior medical students. Of junior medical students, 260 (42.8%) indicated they understood what the intern year, compared to 479 (48.7%) of intermediate medical students. Initiatives to continue improving preparedness for the intern year are essential in ensuring a smooth and less stressful transition into the medical workforce