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  1. Hospitalist career decisions among internal medicine residents.

    Science.gov (United States)

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

    2014-07-01

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 Of the 951 PGY-3 residents planning a HM career among the 9,501 residents responding in all 3 years, 128 (13.5 %) originally made this decision in PGY-1, 192 (20.2 %) in PGY-2, and 631 (66.4 %) in PGY-3.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

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

    Directory of Open Access Journals (Sweden)

    Victor O. Kolade

    2014-07-01

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

  3. 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…

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

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    West, Colin P; Dupras, Denise M

    2012-12-05

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

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

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    Jones, Roger; Panda, Mukta; Desbiens, Norman

    2008-01-01

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

  6. 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.

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

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

    2014-01-01

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

  8. 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

  9. 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...

  10. Permanent resident

    Directory of Open Access Journals (Sweden)

    John F. Fisher

    2016-05-01

    Full Text Available The training of physicians in the past century was based primarily on responsibility and the chain-of-command. Those with the bulk of that responsibility in the fields of pediatrics and internal medicine were residents. Residents trained the medical students and supervised them carefully in caring for patients. Most attending physicians supervised their teams at arm's length, primarily serving as teachers of the finer points of diagnosis and treatment during set periods of the day or week with a perfunctory signature on write-ups or progress notes. Residents endeavored to protect the attending physician from being heavily involved unless they were unsure about a clinical problem. Before contacting the attending physician, a more senior resident would be called. Responsibility was the ultimate teacher. The introduction of diagnosis-related groups by the federal government dramatically changed the health care delivery system, placing greater emphasis on attending physician visibility in the medical record, ultimately resulting in more attending physician involvement in day-to-day care of patients in academic institutions. Without specified content in attending notes, hospital revenues would decline. Although always in charge technically, attending physicians increasingly have assumed the role once dominated by the resident. Using biographical experiences of more than 40 years, the author acknowledges and praises the educational role of responsibility in his own training and laments its declining role in today's students and house staff.

  11. 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.

  12. 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.

  13. 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

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

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    Zeger, Scott L.; Kolars, Joseph C.

    2007-01-01

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

  15. 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.

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

    Science.gov (United States)

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

    2016-10-01

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

  17. 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.

  18. Real time curriculum map for internal medicine residency

    Directory of Open Access Journals (Sweden)

    Roberts J Mark

    2007-11-01

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

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

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Kahn JS

    2017-08-01

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

  1. 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

  2. Internal Medicine residents use heuristics to estimate disease probability

    Directory of Open Access Journals (Sweden)

    Sen Phang

    2015-12-01

    Conclusions: Our findings suggest that despite previous exposure to the use of Bayesian reasoning, residents use heuristics, such as the representative heuristic and anchoring with adjustment, to estimate probabilities. Potential reasons for attribute substitution include the relative cognitive ease of heuristics vs. Bayesian reasoning or perhaps residents in their clinical practice use gist traces rather than precise probability estimates when diagnosing.

  3. Internal Medicine residents use heuristics to estimate disease probability

    OpenAIRE

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

    2015-01-01

    Background: Training in Bayesian reasoning may have limited impact on accuracy of probability estimates. In this study, our goal was to explore whether residents previously exposed to Bayesian reasoning use heuristics rather than Bayesian reasoning to estimate disease probabilities. We predicted that if residents use heuristics then post-test probability estimates would be increased by non-discriminating clinical features or a high anchor for a target condition. Method: We randomized 55 In...

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

    Science.gov (United States)

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

    2006-01-01

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

  5. A Reduced Duty Hours Model for Senior Internal Medicine Residents: A Qualitative Analysis of Residents' Experiences and Perceptions.

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    Mathew, Rebecca; Gundy, Serena; Ulic, Diana; Haider, Shariq; Wasi, Parveen

    2016-09-01

    To assess senior internal medicine residents' experience of the implementation of a reduced duty hours model with night float, the transition from the prior 26-hour call system, and the new model's effects on resident quality of life and perceived patient safety in the emergency department and clinical teaching unit at McMaster University. Qualitative data were collected during May 2013-July 2014, through resident focus groups held prior to implementation of a reduced duty hours model and 10 to 12 months postimplementation. Data analysis was guided by a constructivist grounded theory based in a relativist paradigm. Transcripts were coded; codes were collapsed into themes. Thematic analysis revealed five themes. Residents described reduced fatigue in the early morning, counterbalanced with worsened long-term fatigue on night float blocks; anticipation of negative impacts of the loss of distributed on-call experience and on-call shift volume; an urgency to sleep postcall in anticipation of consecutive night float shifts accompanied by conflicting role demands to stay postcall for care continuity; increased handover frequency accompanied by inaccurate/incomplete communication of patients' issues; and improvement in the senior resident experience on the clinical teaching unit, with increased ownership over patient care and improved relationships with junior housestaff. A reduced duty hours model with night float has potential to improve residents' perceived fatigue on call and care continuity on the clinical teaching unit. This must be weighed against increased handover frequency and loss of the postcall day, which may negatively affect patient care and resident quality of life.

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

    Science.gov (United States)

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

    2017-01-01

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

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

    Science.gov (United States)

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

    2012-12-01

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

  8. 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.)

  9. Use of Team-Based Learning Pedagogy for Internal Medicine Ambulatory Resident Teaching.

    Science.gov (United States)

    Balwan, Sandy; Fornari, Alice; DiMarzio, Paola; Verbsky, Jennifer; Pekmezaris, Renee; Stein, Joanna; Chaudhry, Saima

    2015-12-01

    Team-based learning (TBL) is used in undergraduate medical education to facilitate higher-order content learning, promote learner engagement and collaboration, and foster positive learner attitudes. There is a paucity of data on the use of TBL in graduate medical education. Our aim was to assess resident engagement, learning, and faculty/resident satisfaction with TBL in internal medicine residency ambulatory education. Survey and nominal group technique methodologies were used to assess learner engagement and faculty/resident satisfaction. We assessed medical learning using individual (IRAT) and group (GRAT) readiness assurance tests. Residents (N = 111) involved in TBL sessions reported contributing to group discussions and actively discussing the subject material with other residents. Faculty echoed similar responses, and residents and faculty reported a preference for future teaching sessions to be offered using the TBL pedagogy. The average GRAT score was significantly higher than the average IRAT score by 22%. Feedback from our nominal group technique rank ordered the following TBL strengths by both residents and faculty: (1) interactive format, (2) content of sessions, and (3) competitive nature of sessions. We successfully implemented TBL pedagogy in the internal medicine ambulatory residency curriculum, with learning focused on the care of patients in the ambulatory setting. TBL resulted in active resident engagement, facilitated group learning, and increased satisfaction by residents and faculty. To our knowledge this is the first study that implemented a TBL program in an internal medicine residency curriculum.

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

    Science.gov (United States)

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

    2017-06-01

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

  11. Evaluation of a Substance Use Disorder Curriculum for Internal Medicine Residents

    Science.gov (United States)

    Stein, Melissa R.; Arnsten, Julia H.; Parish, Sharon J.; Kunins, Hillary V.

    2011-01-01

    Teaching about diagnosis, treatment, and sequelae of substance use disorders (SUDs) is insufficient in most Internal Medicine residency programs. To address this, the authors developed, implemented, and evaluated a novel and comprehensive SUD curriculum for first year residents (interns) in Internal Medicine, which anchors the ensuing 3-year…

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

    Science.gov (United States)

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

    2009-03-01

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

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

    Science.gov (United States)

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

    2009-01-01

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

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

    Science.gov (United States)

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

    2009-03-01

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

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

    Science.gov (United States)

    Blank, Linda L.; And Others

    1984-01-01

    The evaluation processes of 75 internal medicine residencies visited by the American Board of Internal Medicine (ABIM) in 1978-82 are reviewed. The methods of evaluation used by the residencies are described and compared with the findings from an earlier cycle of visits in 1972-75. (Author/MLW)

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

    Science.gov (United States)

    Narang, Akhil; Arora, Vineet M

    2015-01-01

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

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

    Science.gov (United States)

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

    2014-06-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Science.gov (United States)

    Edwards, Asher; Nam, Samuel

    2018-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Michael N Daniels

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

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    2011-01-01

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

  3. Preparing International Medical Graduates for Psychiatry Residency: A Multi-Site Needs Assessment

    Science.gov (United States)

    Sockalingam, Sanjeev; Hawa, Raed; Al-Battran, Mazin; Abbey, Susan E.; Zaretsky, Ari

    2012-01-01

    Objective: Despite the growing number of international medical graduates (IMGs) training in medicine in Canada and the United States, IMG-specific challenges early in psychiatry residency have not been fully explored. Therefore, the authors conducted a needs-assessment survey to determine the needs of IMGs transitioning into psychiatry residency.…

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

    Science.gov (United States)

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

    2017-01-01

    Burnout has been documented at high levels in medical residents with negative effects on performance. Some dispositional qualities, like mindfulness, may protect against burnout. The purpose of the present study was to assess burnout prevalence among internal medicine residents at a single institution, examine the relationship between mindfulness and burnout, and provide preliminary findings on the relation between burnout and performance evaluations in internal medicine residents. Residents (n = 38) completed validated measures of burnout at three time points separated by 2 months and a validated measure of dispositional mindfulness at baseline. Program director end-of-year performance evaluations were also obtained on 22 milestones used to evaluate internal medicine resident performance; notably, these milestones have not yet been validated for research purposes; therefore, the investigation here is exploratory. Overall, 71.1% (n = 27) of the residents met criteria for burnout during the study. Lower scores on the "acting with awareness" facet of dispositional mindfulness significantly predicted meeting burnout criteria χ 2 (5) = 11.88, p = 0.04. Lastly, meeting burnout criteria significantly predicted performance on three of the performance milestones, with positive effects on milestones from the "system-based practices" and "professionalism" domains and negative effects on a milestone from the "patient care" domain. Burnout rates were high in this sample of internal medicine residents and rates were consistent with other reports of burnout during medical residency. Dispositional mindfulness was supported as a protective factor against burnout. Importantly, results from the exploratory investigation of the relationship between burnout and resident evaluations suggested that burnout may improve performance on some domains of resident evaluations while compromising performance on other domains. Implications and directions for future research are discussed.

  5. Concussion assessment and management knowledge among chiropractic fourth year interns and residents.

    Science.gov (United States)

    Kazemi, Mohsen; Pichini, Alessandro; Scappaticci, Steven; Savic, Mitchell

    2016-12-01

    To investigate the degree of knowledge chiropractic fourth year interns and post-graduate chiropractic residents have in regard to concussion diagnosis and management. A survey modified from a study conducted by Boggild and Tator (2012), was administered to fourth year chiropractic interns and post-graduate residents via SurveyMonkey.com. Chiropractic fourth year interns and postgraduate chiropractic specialty college residents scored 5.2 and 5.25 out of 9 respectively, which compares well with Bogglid and Tator's reports on medical students and residents. Several knowledge gaps were identified in the sample population. The results from this survey show that the concussion knowledge among Canadian fourth year chiropractic interns and specialty college residents compares favorably with the knowledge of fourth year medical students and residents in diagnosing and managing concussions. Chiropractors appear to possess the skills and knowledge to diagnose and manage concussion equal to their medical counterparts. However, knowledge gaps regarding concussion diagnosis and management were found among chiropractic students and residents.

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

    Science.gov (United States)

    Kawaguchi, S; Mirza, R; Nissim, R; Ridley, J

    2017-05-01

    Internal medicine residents are frequently called upon to provide palliative care to hospitalized patients, but report feeling unprepared to do so effectively. Curricular development to enhance residents' palliative care skills and competencies requires an understanding of current beliefs, attitudes and learning priorities. We conducted a qualitative study consisting of semi-structured interviews with ten internal medicine residents to explore their understanding of and experiences with palliative care. All of the residents interviewed had a sound theoretical understanding of palliative care, but faced many challenges in being able to provide care in practice. The challenges described by residents were system-related, patient-related and provider-related. They identified several priority areas for further learning, and discussed ways in which their current education in palliative care could be enhanced. Our findings provide important insights to guide curricular development for internal medicine trainees. The top five learning priorities in palliative care that residents identified in our study were: 1) knowing how and when to initiate a palliative approach, 2) improving communication skills, 3) improving symptom management skills, 4) identifying available resources, and 5) understanding the importance of palliative care. Residents felt that their education in palliative care could be improved by having a mandatory rotation in palliative care, more frequent didactic teaching sessions, more case-based teaching from palliative care providers, opportunities to be directly observed, and increased support from palliative care providers after-hours.

  7. Residents' and attendings' perceptions of a night float system in an internal medicine program in Canada.

    Science.gov (United States)

    Saxena, Anurag; Desanghere, Loni; Skomro, Robert P; Wilson, Thomas W

    2015-01-01

    The Night Float system (NFS) is often used in residency training programs to meet work hour regulations. The purpose of this study was to examine resident and attendings' perceptions of the NFS on issues of resident learning, well-being, work, non-educational activities and the health care system (patient safety and quality of care, inter-professional teams, workload on attendings and costs of on-call coverage). A survey questionnaire with closed and open-ended questions (26 residents and eight attendings in an Internal Medicine program), informal discussions with the program and moonlighting and financial data were collected. The main findings included, (i) an overall congruency in opinions between resident and attendings across all mean comparisons, (ii) perceptions of improvement for most aspects of resident well-being (e.g. stress, fatigue) and work environment (e.g. supervision, support), (iii) a neutral effect on the resident learning environment, except resident opinions on an increase in opportunities for learning, (iv) perceptions of improved patient safety and quality of care despite worsened continuity of care, and (v) no increases in work-load on attendings or the health care system (cost-neutral call coverage). Patient safety, handovers and increased utilization of moonlighting opportunities need further exploration.

  8. Results of a Formal Mentorship Program for Internal Medicine Residents: Can We Facilitate Genuine Mentorship?

    Science.gov (United States)

    Cohee, Brian M; Koplin, Stephen A; Shimeall, William T; Quast, Timothy M; Hartzell, Joshua D

    2015-03-01

    Mentorship programs are perceived as valuable, yet little is known about the effect of program design on mentoring effectiveness. We developed a program focused on mentoring relationship quality and evaluated how subsequent relationships compared to preexisting informal pairings. Faculty members were invited by e-mail to participate in a new mentoring program. Participants were asked to complete a biography, subsequently provided to second- and third-year internal medicine residents. Residents were instructed to contact available mentors, and ultimately designate a formal mentor. All faculty and residents were provided a half-day workshop training, written guidelines, and e-mails. Reminders were e-mailed and announced in conferences approximately monthly. Residents were surveyed at the end of the academic year. Thirty-seven faculty members completed the biography, and 70% (26 of 37) of residents responded to the survey. Of the resident respondents, 77% (20 of 26) chose a formal mentor. Of the remainder, most had a previous informal mentor. Overall, 96% (25 of 26) of the residents had identified a mentor of some kind compared to 50% (13 of 26) before the intervention (P mentors identified them as actual mentors. Similar numbers of residents described their mentors as invested in the mentorship, and there was no statistical difference in the number of times mentors and mentees met. Facilitated selection of formal mentors produced relationships similar to preexisting informal ones. This model may increase the prevalence of mentorship without decreasing quality.

  9. Residency Allocation Database

    Data.gov (United States)

    Department of Veterans Affairs — The Residency Allocation Database is used to determine allocation of funds for residency programs offered by Veterans Affairs Medical Centers (VAMCs). Information...

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

    Science.gov (United States)

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

    2011-09-07

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

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

    Science.gov (United States)

    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.

  12. 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.

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

    Science.gov (United States)

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

    2015-07-01

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

  14. 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.

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

    Science.gov (United States)

    Wong, Roger Y; Saber, Sadra S; Ma, Irene; Roberts, J Mark

    2009-02-03

    To address evidence-based effective communication skills in the formal academic half day curriculum of our core internal medicine residency program, we designed and delivered an interactive session using excerpts taken from medically-themed television shows. We selected two excerpts from the television show House, and one from Gray's Anatomy and featured them in conjunction with a brief didactic presentation of the Kalamazoo consensus statement on doctor-patient communication. To assess the efficacy of this approach a set of standardized questions were given to our residents once at the beginning and once at the completion of the session. Our residents indicated that their understanding of an evidence-based model of effective communication such as the Kalamazoo model, and their comfort levels in applying such model in clinical practice increased significantly. Furthermore, residents' understanding levels of the seven essential competencies listed in the Kalamazoo model also improved significantly. Finally, the residents reported that their comfort levels in three challenging clinical scenarios presented to them improved significantly. We used popular television shows to teach residents in our core internal medicine residency program about effective communication skills with a focus on the Kalamazoo's model. The results of the subjective assessment of this approach indicated that it was successful in accomplishing our objectives.

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

    Directory of Open Access Journals (Sweden)

    Ma Irene

    2009-02-01

    Full Text Available Abstract Background To address evidence-based effective communication skills in the formal academic half day curriculum of our core internal medicine residency program, we designed and delivered an interactive session using excerpts taken from medically-themed television shows. Methods We selected two excerpts from the television show House, and one from Gray's Anatomy and featured them in conjunction with a brief didactic presentation of the Kalamazoo consensus statement on doctor-patient communication. To assess the efficacy of this approach a set of standardized questions were given to our residents once at the beginning and once at the completion of the session. Results Our residents indicated that their understanding of an evidence-based model of effective communication such as the Kalamazoo model, and their comfort levels in applying such model in clinical practice increased significantly. Furthermore, residents' understanding levels of the seven essential competencies listed in the Kalamazoo model also improved significantly. Finally, the residents reported that their comfort levels in three challenging clinical scenarios presented to them improved significantly. Conclusion We used popular television shows to teach residents in our core internal medicine residency program about effective communication skills with a focus on the Kalamazoo's model. The results of the subjective assessment of this approach indicated that it was successful in accomplishing our objectives.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    Myszkowski, Nils; Villoing, Barbara; Zenasni, Franck; Jaury, Philippe; Boujut, Emilie

    2017-07-01

    Residents experience severely high levels of stress, depression and burnout, leading to perceived medical errors, as well as to symptoms of impairment, such as chronic anger, cognitive impairment, suicidal behavior and substance abuse. Because research has not yet provided a psychometrically robust population-specific tool to measure the level of stress of medicine residents, we aimed at building and validating such a measure. Using an inductive scale development approach, a short, pragmatic measure was built, based on the interviews of 17 medicine residents. The Internal Medicine Residency Stress Scale (IMRSS) was then administered in a sample of 259 internal medicine residents (199 females, 60 males, M Age  = 25.6) along with the Hospital Anxiety and Depression Scale, Maslach Burnout Inventory, Satisfaction With Life Scale and Ways of Coping Checklist. The IMRSS showed satisfactory internal reliability (Cronbach's α = .86), adequate structural validity - studied through Confirmatory Factor Analysis (χ 2 /df = 2.51, CFI = .94; SRMR = .037, RMSEA = .076) - and good criterion validity - the IMRSS was notably strongly correlated with emotional exhaustion (r = .64; p is recommended to quickly and frequently assess and monitor stress among internal medicine residents.

  19. 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

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

    Science.gov (United States)

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

    2004-06-01

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

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

    Science.gov (United States)

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

    2008-06-26

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

  2. 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

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. SU-F-E-12: Elective International Rotations in Medical Physics Residency Programs

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    Brown, D; Mundt, A; Einck, J; Pawlicki, T [University of California, San Diego, La Jolla, CA (United States)

    2016-06-15

    Purpose: The purpose of this educational program is to motivate talented, intelligent individuals to become stakeholders in the global effort to improve access to radiotherapy. Methods: The need to improve global access to radiotherapy has been clearly established and several organizations are making substantial progress in securing funding and developing plans to achieve this worthwhile goal. The incorporation of elective international rotations in residency programs may provide one possible mechanism to promote and support this future investment. We recently incorporated an elective 1-month international rotation into our CAMPEP accredited Medical Physics residency program, with our first rotation taking place in Vietnam. A unique aspect of this rotation was that it was scheduled collaboratively with our Radiation Oncology residency program such that Radiation Oncology and Medical Physics residents traveled to the same clinic at the same time. Results: We believe the international rotation substantially enhances the educational experience, providing additional benefits to residents by increasing cross-disciplinary learning and offering a shared learning experience. The combined international rotation may also increase benefit to the host institution by modeling positive multidisciplinary working relationships between Radiation Oncologists and Medical Physicists. Our first resident returned with several ideas designed to improve radiotherapy in resource-limited settings – one of which is currently being pursued in collaboration with a vendor. Conclusion: The elective international rotation provides a unique learning experience that has the potential to motivate residents to become stakeholders in the global effort to improve access to radiotherapy. What better way to prepare the next generation of Medical Physicists to meet the challenges of improving global access to radiotherapy than to provide them with training experiences that motivate them to be socially

  8. SU-F-E-12: Elective International Rotations in Medical Physics Residency Programs

    International Nuclear Information System (INIS)

    Brown, D; Mundt, A; Einck, J; Pawlicki, T

    2016-01-01

    Purpose: The purpose of this educational program is to motivate talented, intelligent individuals to become stakeholders in the global effort to improve access to radiotherapy. Methods: The need to improve global access to radiotherapy has been clearly established and several organizations are making substantial progress in securing funding and developing plans to achieve this worthwhile goal. The incorporation of elective international rotations in residency programs may provide one possible mechanism to promote and support this future investment. We recently incorporated an elective 1-month international rotation into our CAMPEP accredited Medical Physics residency program, with our first rotation taking place in Vietnam. A unique aspect of this rotation was that it was scheduled collaboratively with our Radiation Oncology residency program such that Radiation Oncology and Medical Physics residents traveled to the same clinic at the same time. Results: We believe the international rotation substantially enhances the educational experience, providing additional benefits to residents by increasing cross-disciplinary learning and offering a shared learning experience. The combined international rotation may also increase benefit to the host institution by modeling positive multidisciplinary working relationships between Radiation Oncologists and Medical Physicists. Our first resident returned with several ideas designed to improve radiotherapy in resource-limited settings – one of which is currently being pursued in collaboration with a vendor. Conclusion: The elective international rotation provides a unique learning experience that has the potential to motivate residents to become stakeholders in the global effort to improve access to radiotherapy. What better way to prepare the next generation of Medical Physicists to meet the challenges of improving global access to radiotherapy than to provide them with training experiences that motivate them to be socially

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

    Science.gov (United States)

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

    2018-07-01

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

  10. 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/.

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

    Science.gov (United States)

    Fok, Mark C; Wong, Roger Y

    2014-11-28

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

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

    Science.gov (United States)

    Aksoy, Duygu Yazgan; Durusu Tanriover, Mine; Unal, Sule; Dizdar, Omer; Kalyoncu, Umut; Karakaya, Jale; Unal, Serhat; Kale, Gulsev

    2014-01-01

    The purpose of this paper is to demonstrate burnout syndrome among internal medicine and pediatrics residents in a country that does not have the working time directive (WTD) and also to determine the risk factors and consequent impact on efficient functioning in clinical areas. A 57-item questionnaire was given to internal medicine and pediatrics residents. Responses from 22 pediatrics and 33 internal medicine residents were evaluated. Demographic findings, burnout scores, having hobbies, social activities and reading books unrelated to medicine were similar between the two groups. Six pediatrics residents (27.3 per cent) and 11 (33.3 per cent) internal medicine residents met the criteria for clinically significant burnout. Personal accomplishment scores and reading books unrelated to medicine were found to be related to burnout. Burnout is a syndrome characterized by depersonalization, emotional exhaustion and a low sense of personal accomplishment. It is important to document burnout in countries where WTDs are not implemented. Further studies might demonstrate burnout's effect on patient safety, service quality and physician's performance.

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

    Science.gov (United States)

    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

  14. Cultural transition of international medical graduate residents into family practice in Canada.

    Science.gov (United States)

    Triscott, Jean A C; Szafran, Olga; Waugh, Earle H; Torti, Jacqueline M I; Barton, Martina

    2016-05-04

    To identify the perceived strengths that international medical graduate (IMG) family medicine residents possess and the challenges they are perceived to encounter in integrating into Canadian family practice. This was a qualitative, exploratory study employing focus groups and interviews with 27 participants - 10 family physicians, 13 health care professionals, and 4 family medicine residents. Focus group/interview questions addressed the strengths that IMGs possess and the challenges they face in becoming culturally competent within the Canadian medico-cultural context. Qualitative data were audiotaped, transcribed, and analyzed thematically. Participants identified that IMG residents brought multiple strengths to Canadian practice including strong clinical knowledge and experience, high education level, the richness of varied cultural perspectives, and positive personal strengths. At the same time, IMG residents appeared to experience challenges in the areas of: (1) communication skills (language nuances, unfamiliar accents, speech volume/tone, eye contact, directness of communication); (2) clinical practice (uncommon diagnoses, lack of familiarity with care of the opposite sex and mental health conditions); (3) learning challenges (limited knowledge of Canada's health care system, patient-centered care and ethical principles, unfamiliarity with self-directed learning, unease with receiving feedback); (4) cultural differences (gender roles, gender equality, personal space, boundary issues; and (5) personal struggles. Residency programs must recognize the challenges that can occur during the cultural transition to Canadian family practice and incorporate medico-cultural education into the curriculum. IMG residents also need to be aware of cultural differences and be open to different perspectives and new learning.

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

    Science.gov (United States)

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

    2011-10-01

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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

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

    2016-12-01

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

  20. 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.

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

    Science.gov (United States)

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

    1991-01-01

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

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

    Science.gov (United States)

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

    2018-02-06

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

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

    Science.gov (United States)

    2010-01-01

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

  4. Resident Characteristics Report

    Data.gov (United States)

    Department of Housing and Urban Development — The Resident Characteristics Report summarizes general information about households who reside in Public Housing, or who receive Section 8 assistance. The report...

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

    Science.gov (United States)

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

    2008-06-03

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

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

    Science.gov (United States)

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

    2001-01-01

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

  7. Development and Implementation of a Web-based Evaluation System for an Internal Medicine Residency Program.

    Science.gov (United States)

    Rosenberg, Mark E.; Watson, Kathleen; Paul, Jeevan; Miller, Wesley; Harris, Ilene; Valdivia, Tomas D.

    2001-01-01

    Describes the development and implementation of a World Wide Web-based electronic evaluation system for the internal medicine residency program at the University of Minnesota. Features include automatic entry of evaluations by faculty or students into a database, compliance tracking, reminders, extensive reporting capabilities, automatic…

  8. 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...

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

    Directory of Open Access Journals (Sweden)

    Kassam Narmin

    2011-06-01

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

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

    Science.gov (United States)

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

    2011-07-01

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

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

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

    2015-12-01

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

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

    Science.gov (United States)

    Ren, Vicky; Ellison, Kathleen; Miller, Jonathan; Busireddy, Kiran; Vickery, Erin; Panda, Mukta; Qayyum, Rehan

    2016-01-01

    Screening adult patients for obesity and offering appropriate counseling and treatment for weight loss is recommended. However, many healthcare providers feel ill-equipped to address this topic. We examined whether didactic presentations lead to increased obesity documentation and counseling among internal medicine (IM) residents. We reviewed medical records of patients seen at the IM Resident Continuity Clinic during April 2015. Residents were provided feedback at two didactic presentations during May 2015. To examine the effect of this intervention, we repeated medical record review during June 2015. For both reviews, we abstracted patient-specific (i.e., age, body mass index [BMI], race, sex, and number of comorbid diagnoses) and resident-specific (i.e., sex and training level) data as well as evidence of obesity documentation and counseling. We used logistic regression models to examine the effect of intervention on obesity documentation and counseling, adjusting for patient- and resident-specific variables. Of the 278 patients with BMI≥30 kg/m(2), 139 were seen before and 139 after the intervention. Intervention had no effect on obesity documentation or counseling with or without adjustment for confounding variables (both P>0.05). In adjusted post-hoc analyses, each additional comorbidity increased the odds of obesity documentation by 8% (OR=1.08; 95% CI=1.05-1.11; Pdidactic presentations were unable to increase obesity documentation or weight loss counseling. Future research to identify effective interventions is needed.

  15. 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

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

    Science.gov (United States)

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

    2004-06-01

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

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

    Science.gov (United States)

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

    2004-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Steven J Durning

    2013-10-01

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

  19. 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 ...

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

    Science.gov (United States)

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

    2018-05-15

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

  1. Minimal Internal Radiation Exposure in Residents Living South of the Fukushima Daiichi Nuclear Power Plant Disaster.

    Science.gov (United States)

    Akiyama, Junichi; Kato, Shigeaki; Tsubokura, Masaharu; Mori, Jinichi; Tanimoto, Tetsuya; Abe, Koichiro; Sakai, Shuji; Hayano, Ryugo; Tokiwa, Michio; Shimmura, Hiroaki

    2015-01-01

    Following the Fukushima nuclear power plant disaster, assessment of internal radiation exposure was indispensable to predict radiation-related health threats to residents of neighboring areas. Although many evaluations of internal radiation in residents living north and west of the crippled Fukushima nuclear power plant are available, there is little information on residents living in areas south of the plant, which were similarly affected by radio-contamination from the disaster. To assess the internal radio-contamination in residents living in affected areas to the south of the plant or who were evacuated into Iwaki city, a whole body counter (WBC) screening program of internal radio-contamination was performed on visitors to the Jyoban hospital in Iwaki city, which experienced less contamination than southern areas adjacent to the nuclear plant. The study included 9,206 volunteer subjects, of whom 6,446 were schoolchildren aged 4-15 years. Measurements began one year after the incident and were carried out over the course of two years. Early in the screening period only two schoolchildren showed Cs-137 levels that were over the detection limit (250 Bq/body), although their Cs-134 levels were below the detection limit (220 Bq/body). Among the 2,760 adults tested, 35 (1.3%) had detectable internal radio-contamination, but only for Cs-137 (range: 250 Bq/body to 859 Bq/body), and not Cs-134. Of these 35 subjects, nearly all (34/35) showed elevated Cs-137 levels only during the first year of the screening. With the exception of potassium 40, no other radionuclides were detected during the screening period. The maximum annual effective dose calculated from the detected Cs-137 levels was 0.029 and 0.028 mSv/year for the schoolchildren and adults, respectively, which is far below the 1 mSv/year limit set by the government of Japan. Although the data for radiation exposure during the most critical first year after the incident are unavailable due to a lack of systemic

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

    Science.gov (United States)

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

    2018-03-01

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

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

    Science.gov (United States)

    Panda, Mukta; Desbiens, Norman A

    2010-12-01

    Lifelong learning is an integral component of practice-based learning and improvement. Physicians need to be lifelong learners to provide timely, efficient, and state-of-the-art patient care in an environment where knowledge, technology, and social requirements are rapidly changing. To assess graduates' self-reported perception of the usefulness of a residency program requirement to submit a narrative report describing their planned educational modalities for their future continued medical learning ("Education for Life" requirement), and to compare the modalities residents intended to use with their reported educational activities. Data was compiled from the Education for Life reports submitted by internal medicine residents at the University of Tennessee College of Medicine Chattanooga from 1998 to 2000, and from a survey sent to the same 27 graduates 2 to 4 years later from 2000 to 2004. Twenty-four surveys (89%) were returned. Of the responding graduates, 58% (14/24) found the Education for Life requirement useful for their future continued medical learning. Graduates intended to keep up with a mean of 3.4 educational modalities, and they reported keeping up with 4.2. In a multivariable analysis, the number of modalities graduates used was significantly associated with the number they had planned to use before graduation (P  =  .04) but not with their career choice of subspecialization. The majority of residents found the Education for Life requirement useful for their future continued medical learning. Graduates, regardless of specialty, reported using more modalities for continuing their medical education than they thought they would as residents. Considering lifelong learning early in training and then requiring residents to identify ways to practice lifelong learning as a requirement for graduation may be dispositive.

  4. The Impact of Supervision on Internal Medicine Residents' Attitudes and Management of Depression in Primary Care: A Pilot Study

    Science.gov (United States)

    Milone, Jennifer M.; Gottumukkala, Aruna; Ward, Christopher P.; York, Kaki M.

    2013-01-01

    Objective: The authors examined the effect of supervision on internal medicine residents' attitudes toward and management of depression. Method: Internal medicine residents completed a survey during preclinical conferences. The survey included a published, validated questionnaire, the Depression Attitude Questionnaire, and items developed by the…

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

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

    2013-06-01

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

  7. 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.

    Science.gov (United States)

    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.

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

    Science.gov (United States)

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

    2015-01-01

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

  9. 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.

  10. [Burnout in nursing residents].

    Science.gov (United States)

    Franco, Gianfábio Pimentel; de Barros, Alba Lúcia Bottura Leite; Nogueira-Martins, Luiz Antônio; Zeitoun, Sandra Salloum

    2011-03-01

    Nursing residents may experience physical and emotional exhaustion from the daily life of attending the Program. The aim of this study was to determine the Burnout incidence among Nursing Residents. An investigative, descriptive, analytical, longitudinal-prospective study was conducted with 16 Residents over two years. The Maslach Burnout Inventory was used, translated and validated for Brazil, as well as a sociodemographic/occupational data tool. Of all residents, 17.2% showed high rates in Emotional Exhaustion and Depersonalization; 18.8% showed impaired commitment in Personal Accomplishment, 75% of which belonged to specialty areas, such as Emergency Nursing, Adult and Pediatric Intensive Care. Age and specialty area were positively correlated with Personal Accomplishment. One of the Residents was identified with changes in three subscales of the Maslach Burnout Inventory, thus characterized as a Burnout Syndrome patient. Nursing Residents have profiles of disease. Knowing these factors can minimize health risks of these workers.

  11. Female residents experiencing medical errors in general internal medicine: a qualitative study.

    Science.gov (United States)

    Mankaka, Cindy Ottiger; Waeber, Gérard; Gachoud, David

    2014-07-10

    Doctors, especially doctors-in-training such as residents, make errors. They have to face the consequences even though today's approach to errors emphasizes systemic factors. Doctors' individual characteristics play a role in how medical errors are experienced and dealt with. The role of gender has previously been examined in a few quantitative studies that have yielded conflicting results. In the present study, we sought to qualitatively explore the experience of female residents with respect to medical errors. In particular, we explored the coping mechanisms displayed after an error. This study took place in the internal medicine department of a Swiss university hospital. Within a phenomenological framework, semi-structured interviews were conducted with eight female residents in general internal medicine. All interviews were audiotaped, fully transcribed, and thereafter analyzed. Seven main themes emerged from the interviews: (1) A perception that there is an insufficient culture of safety and error; (2) The perceived main causes of errors, which included fatigue, work overload, inadequate level of competences in relation to assigned tasks, and dysfunctional communication; (3) Negative feelings in response to errors, which included different forms of psychological distress; (4) Variable attitudes of the hierarchy toward residents involved in an error; (5) Talking about the error, as the core coping mechanism; (6) Defensive and constructive attitudes toward one's own errors; and (7) Gender-specific experiences in relation to errors. Such experiences consisted in (a) perceptions that male residents were more confident and therefore less affected by errors than their female counterparts and (b) perceptions that sexist attitudes among male supervisors can occur and worsen an already painful experience. This study offers an in-depth account of how female residents specifically experience and cope with medical errors. Our interviews with female residents convey the

  12. Internal Structure of Mini-CEX Scores for Internal Medicine Residents: Factor Analysis and Generalizability

    Science.gov (United States)

    Cook, David A.; Beckman, Thomas J.; Mandrekar, Jayawant N.; Pankratz, V. Shane

    2010-01-01

    The mini-CEX is widely used to rate directly observed resident-patient encounters. Although several studies have explored the reliability of mini-CEX scores, the dimensionality of mini-CEX scores is incompletely understood. Objective: Explore the dimensionality of mini-CEX scores through factor analysis and generalizability analysis. Design:…

  13. Expectations of iPad use in an internal medicine residency program: is it worth the "hype"?

    Science.gov (United States)

    Luo, Nancy; Chapman, Christopher G; Patel, Bhakti K; Woodruff, James N; Arora, Vineet M

    2013-05-08

    While early reports highlight the benefits of tablet computing in hospitals, introducing any new technology can result in inflated expectations. The aim of the study is to compare anticipated expectations of Apple iPad use and perceptions after deployment among residents. 115 internal medicine residents received Apple iPads in October 2010. Residents completed matched surveys on anticipated usage and perceptions after distribution 1 month prior and 4 months after deployment. In total, 99% (114/115) of residents responded. Prior to deployment, most residents believed that the iPad would improve patient care and efficiency on the wards; however, fewer residents "strongly agreed" after deployment (34% vs 15% for patient care, PApple iOS product owners were also more likely to use the iPad in key areas. Overall, 84% of residents thought the iPad was a good investment for the residency program, and over half of residents (58%) reported that patients commented on the iPad in a positive way. While the use of tablets such as the iPad by residents is generally well received, high initial expectations highlight the danger of implementing new technologies. Education on the realistic expectations of iPad benefits may be warranted.

  14. Expectations of iPad Use in an Internal Medicine Residency Program: Is It Worth the “Hype”?

    Science.gov (United States)

    Luo, Nancy; Chapman, Christopher G; Patel, Bhakti K; Woodruff, James N

    2013-01-01

    Background While early reports highlight the benefits of tablet computing in hospitals, introducing any new technology can result in inflated expectations. Objective The aim of the study is to compare anticipated expectations of Apple iPad use and perceptions after deployment among residents. Methods 115 internal medicine residents received Apple iPads in October 2010. Residents completed matched surveys on anticipated usage and perceptions after distribution 1 month prior and 4 months after deployment. Results In total, 99% (114/115) of residents responded. Prior to deployment, most residents believed that the iPad would improve patient care and efficiency on the wards; however, fewer residents “strongly agreed” after deployment (34% vs 15% for patient care, PiPad for placing orders post call and during admission (71% vs 44% post call, P=.01, and 16% vs 0% admission, P=.04). Previous Apple iOS product owners were also more likely to use the iPad in key areas. Overall, 84% of residents thought the iPad was a good investment for the residency program, and over half of residents (58%) reported that patients commented on the iPad in a positive way. Conclusions While the use of tablets such as the iPad by residents is generally well received, high initial expectations highlight the danger of implementing new technologies. Education on the realistic expectations of iPad benefits may be warranted. PMID:23656727

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

    Science.gov (United States)

    Miller, Rachel K; Michener, Jennifer; Yang, Phyllis; Goldstein, Karen; Groce-Martin, Jennine; True, Gala; Johnson, Jerry

    2017-09-01

    Community-based service learning (CBSL) provides an opportunity to teach internal medicine residents the social context of aging and clinical concepts. The objectives of the current study were to demonstrate the feasibility of a CBSL program targeting internal medicine residents and to assess its effect on medical residents and community participants. internal medicine residents participated in a CBSL experience for half a day during ambulatory blocks from 2011 to 2014. Residents attended a senior housing unit or center, delivered a presentation about a geriatric health topic, toured the facility, and received information about local older adult resources. Residents evaluated the experience. Postgraduate Year 3 internal medicine residents (n = 71) delivered 64 sessions. Residents felt that the experience increased their ability to communicate effectively with older adults (mean 3.91 ± 0.73 on a Likert scale with 5 = strongly agree), increased their knowledge of resources (4.09 ± 1.01), expanded their knowledge of a health topic pertinent to aging (3.48 ± 1.09), and contributed to their capacity to evaluate and care for older adults (3.84 ± 0.67). Free-text responses demonstrated that residents thought that this program would change their practice. Of 815 older adults surveyed from 36 discrete teaching sessions, 461 (56%) thought that the medical residents delivered health information clearly (4.55 ± 0.88) and that the health topics were relevant (4.26 ± 0.92). Free-text responses showed that the program helped them understand their health concerns. This CBSL program is a feasible and effective tool for teaching internal medicine residents and older adults. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  16. Internal Medicine Residents' Training in Substance Use Disorders: A Survey of the Quality of Instruction and Residents' Self-Perceived Preparedness to Diagnose and Treat Addiction

    Science.gov (United States)

    Wakeman, Sarah E.; Baggett, Meridale V.; Pham-Kanter, Genevieve; Campbell, Eric G.

    2013-01-01

    Background: Resident physicians are the direct care providers for many patients with addiction. This study assesses residents' self-perceived preparedness to diagnose and treat addiction, measures residents' perceptions of the quality of addictions instruction, and evaluates basic knowledge of addictions. Methods: A survey was e-mailed to 184…

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    Salib, Sherine; Glowacki, Elizabeth M; Chilek, Lindsay A; Mackert, Michael

    2015-06-01

    Learning effective communication is essential for physicians. Effective communication has been shown to affect healthcare outcomes, including patient safety, adherence rates, patient satisfaction, and enhanced teamwork. The importance of these skills has become even more apparent in recent years, with value-based purchasing programs and federal measures of patient satisfaction in the form of Hospital Consumer Assessment of Healthcare Providers and Systems scores becoming an important part of measuring the performance of a healthcare facility. We conducted a communication workshop for internal medicine residents at the University of Texas. Topics covered included the Acknowledge, Introduce, Duration, Explanation, Thank You framework; managing up; resolving conflicts; error disclosure; new medication and discharge counseling; intercultural communication; understanding Hospital Consumer Assessment of Healthcare Providers and Systems scores; and avoiding burnout. Because it would have been logistically difficult to block whole days for the workshop, the various topics were offered to residents during their regular noon conference hour for several consecutive days. After the workshop, the residents completed an anonymous questionnaire regarding their perception of the importance of various aspects of communication in patient care. The majority of the participating residents perceived the various communication skills explored during the workshop to be highly important in patient care. Concurrently, however, most residents believed that they had initially overestimated their knowledge about these various communication issues. Some demographic differences in the responses also were noted. Our findings demonstrate a needs gap and an area of potential improvement in medical education. We anticipate that with the growing understanding of the importance of communication skills in the healthcare setting, there will be an enhanced role for teaching these skills at all levels of

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

    Science.gov (United States)

    Tufan, Fatih; Yuruyen, Mehmet; Kizilarslanoglu, Muhammet Cemal; Akpinar, Timur; Emiksiye, Sirhan; Yesil, Yusuf; Ozturk, Zeynel Abidin; Bozbulut, Utku Burak; Bolayir, Basak; Tasar, Pinar Tosun; Yavuzer, Hakan; Sahin, Sevnaz; Ulger, Zekeriya; Ozturk, Gulistan Bahat; Halil, Meltem; Akcicek, Fehmi; Doventas, Alper; Kepekci, Yalcin; Ince, Nurhan; Karan, Mehmet Akif

    2015-01-01

    The number of older people is growing fast in Turkey. In this context, internal medicine residents and specialists contact older people more frequently. Thus, healthcare providers' knowledge and attitudes toward older people is becoming more important. Studies that specifically investigate internal medicine residents' attitudes toward the elderly are scarce. We aimed to investigate the attitudes of internal medicine residents toward older people. This cross-sectional multicenter study was undertaken in the internal medicine clinics of six university state hospitals that provide education in geriatric care. All internal medicine residents working in these hospitals were invited to participate in this questionnaire study between March 2013 and December 2013. We recorded the participants' age, sex, duration of internal medicine residency, existence of relatives older than 65 years, history of geriatrics course in medical school, geriatrics rotation in internal medicine residency, and nursing home visits. A total of 274 (82.3%) of the residents participated in this study, and 83.6% of them had positive attitudes toward older people. A geriatrics rotation during internal medicine residency was the only independent factor associated with positive attitudes toward the elderly in this multivariate analysis. A geriatrics course during medical school was associated with positive attitudes in the univariate analysis, but only tended to be so in the multivariate analysis. Geriatrics rotation during internal medicine residency was independently associated with positive attitudes toward older people. Generalization of geriatrics education in developing countries may translate into a better understanding and improved care for older patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2016-12-06

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

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    Umeizudike, Kehinde A; Iwuala, Sandra O; Ozoh, Obianuju B; Ayanbadejo, Patricia O; Fasanmade, Olufemi A

    2016-01-01

    To assess internal medicine residents' knowledge of associations between periodontal disease and systemic illnesses, and attitudes toward patients' periodontal health. A cross-sectional survey using a self-administered questionnaire was conducted among internal medicine residents attending the Faculty of Internal Medicine 2014 Update Course organized by the National Postgraduate Medical College of Nigeria. Participants came from all over the country. Data on respondents' demographic characteristics, periodontal disease knowledge, knowledge of associations between periodontal disease and systemic illnesses, and attitudes toward patients' periodontal health were collected. Data were analyzed using Epi INFO software. The Pearson chi square test was used to measure significant association between categorical variables such as the knowledge of periodontal disease and gender, age group and designation of the participants (p ⩽ 0.05). Of 150 questionnaires distributed, 123 were returned (82% response rate); 109 questionnaires were completed properly and included in the analysis. The most common source of residents' information on oral health was television (59.4%). Only 11.2% of respondents were aware that gingival bleeding was the earliest sign of periodontal disease. Respondents correctly identified periodontal disease as a risk factor for coronary heart disease (45.9%), stroke (43.5%), hospital-acquired pneumonia (53.2%), diabetes mellitus (13.8%), and preterm birth (11%). Increased age (p = 0.032) and male gender (p = 0.022) were associated significantly with knowledge of periodontal disease as a risk factor for stroke. Higher designation (p = 0.002) and longer duration in residency training (p = 0.004) were associated significantly with knowledge of periodontal disease as risk factor for peripheral arterial disease. The majority (90.9%) of respondents had positive attitudes toward the referral of their patients for regular periodontal care. Knowledge of

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

    Science.gov (United States)

    Mansi, Ishak A

    2011-03-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  8. 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.

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

    Science.gov (United States)

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

    2014-01-01

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

  10. Residents in difficulty

    DEFF Research Database (Denmark)

    Christensen, Mette Krogh; O'Neill, Lotte; Hansen, Dorthe Høgh

    2016-01-01

    Background The majority of studies on prevalence and characteristics of residents in difficulty have been conducted in English-speaking countries and the existing literature may not reflect the prevalence and characteristics of residents in difficulty in other parts of the world such as the Scand...... in a healthcare system. From our perspective, further sociological and pedagogical investigations in educational cultures across settings and specialties could inform our understanding of and knowledge about pitfalls in residents’ and doctors’ socialization into the healthcare system....

  11. STarDom study - Applying systems theory framework for Internal Medicine senior residency career development in a Singapore ACGMEI Residency Programme

    Directory of Open Access Journals (Sweden)

    Joanne Kua

    2018-05-01

    Full Text Available Aims: Career counselling is a complex process. Traditional career counselling is unidirectional in approach and ignores the impact and interactions of other factors. The Systems Theory Framework (STF is an emerging framework that illustrates the dynamic and complex nature of career development. Our study aims to i explore factors affecting senior residency (SR subspecialty choices, and ii determine the suitable utility of the STF in career counselling. Methods: A prospective observational cohort study of internal medicine residents was done. Surveys were collected at three time points. The Specialty Indecision Scale (SIS assesses the individual components and expert consensus group derived the questions for the contextual components. We measured burnout using the Mashlach Burnout Inventory. Process influences were assessed via thematic analysis of open-ended question at the 3rd survey. Results: 82 responses were collected. There was a trend towards older residents being ready to commit albeit not statistically significant. At year 1, overseas graduands (OR = 6.87, p= 0.02, lifestyle factors (t(29=2.31, p=0.03, d= 0.91, individual factors of readiness (t(29 = -2.74, p=0.01, d= 1.08, indecisiveness (t(27= -0.57, p=0.02, d= 0.99 and self- doubt (t(29= -4.02, p=0.00, d= 1.54 predicted the resident’s ability to commit to SR. These factors change and being married (OR 4.49, p= 0.03 was the only factor by the 3rd survey. Male residents are more resolute in their choice (OR= 5.17, p= 0.02. Conclusion: The resident’s choice of SR changes over time. The STF helps in understanding decision-making about subspecialty choices. Potential applications include: i initiation of career counselling at year 1 and ii reviewing unpopular SR subspecialties to increase their attractiveness.

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

    Science.gov (United States)

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

    2013-11-01

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

  13. "It's Not Just Time Off": A Framework for Understanding Factors Promoting Recovery From Burnout Among Internal Medicine Residents.

    Science.gov (United States)

    Abedini, Nauzley C; Stack, Shobha W; Goodman, Jessie L; Steinberg, Kenneth P

    2018-02-01

    Burnout rates for internal medicine residents are among the highest of all specialties, yet little is known about how residents recover from burnout. We identified factors promoting recovery from burnout and factors that assist with the subsequent avoidance of burnout among internal medicine residents. A purposive sample of postgraduate year 2 (PGY-2), PGY-3, and recent graduates who experienced and recovered from burnout during residency participated in semistructured, 60-minute interviews from June to August 2016. Using qualitative methods derived from grounded theory, saturation of themes occurred after 25 interviews. Coding was performed in an iterative fashion and consensus was reached on major themes. Coding revealed 2 different categories of resident burnout- circumstantial and existential -with differing recovery and avoidance methods. Circumstantial burnout stemmed from self-limited circumstances and environmental triggers. Recovery from, and subsequent avoidance of, circumstantial burnout arose from (1) resolving workplace challenges; (2) nurturing personal lives; and (3) taking time off. In contrast, existential burnout stemmed from a loss of meaning in medicine and an uncertain professional role. These themes were identified around recovery: (1) recognizing burnout and feeling validated; (2) connecting with patients and colleagues; (3) finding meaning in medicine; and (4) redefining a professional identity and role. Our study suggests that residents experience different types of burnout and have variable methods by which they recover from and avoid further burnout. Categorizing residents' burnout into circumstantial versus existential experiences may serve as a helpful framework for formulating interventions.

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

    Science.gov (United States)

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

    2017-04-18

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

  15. Burnout Syndrome During Residency.

    Science.gov (United States)

    Turgut, Namigar; Karacalar, Serap; Polat, Cengiz; Kıran, Özlem; Gültop, Fethi; Kalyon, Seray Türkmen; Sinoğlu, Betül; Zincirci, Mehmet; Kaya, Ender

    2016-10-01

    The aim of this study is identified the degree of Burnout Syndrome (BOS) and find out its correlation with years of recidency and sociodemograpfic chareacteristics, training, sleeping habits, such as smoking and alcohol consumption. After approval from the Hospital Ethics Committee and obtaining informed consent, First, second, third, fourth and fifth year of recidency staff (n=127) working in our hospital were involved in this study. The standardized Maslach Burnout Inventory (MBI) was used in this study. Fifty six male (44.1%) and seventy one female (55.9%) residents were enroled in this study (Coranbach Alfa(α)=0.873). 57% of the first year residents smokes cigaret and 54% of them use alcohol. 2% of them gets one day off after hospital night shift, 61% of them suffers from disturbed sleep. 60% of them had been stated that they willingly selected their profession. 61% of them prefers talking to friends and 32% of them prefers shopping to overcome stress. There were statistical difference acording to years of recidency in MBI, Emotional Burnout (EB) and desensitisation scale (DS) points. EB scale points of the second year of residency group was statisticaly higher than fourth year of residency group. DS points of second year of residency group was also statisticaly higher than the third and fourth year of residency group. There was no statistical difference between any groups in Personal Success. BOS is a frequent problem during residency in anaesthesia. Appropriate definition and awareness are the first important steps to prevent this syndrome. Further administrative approaches should be evaluated with regard to their effects.

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

    Science.gov (United States)

    Willett, Lisa L; Halvorsen, Andrew J; McDonald, Furman S; Chaudhry, Saima I; Arora, Vineet M

    2015-06-01

    Whether salary disparities exist between men and women in medical education leadership roles is not known. The study objective was to determine whether salary disparities exist between male and female Internal Medicine residency program directors, and if so, to identify factors associated with the disparities and explore historical trends. The annual Association of Program Directors in Internal Medicine (APDIM) survey in August 2012 included items to assess the salary and demographic characteristics of program directors, which were merged with publically available program data. To assess historical trends, we used similarly obtained survey data from 2008 to 2011. The study included program directors of 370 APDIM member programs, representing 95.6% of the 387 accredited Internal Medicine training programs in the United States and Puerto Rico. Of the 370 APDIM member programs, 241 (65.1%) completed the survey, of whom 169 (70.1%) were men and 72 (29.9%) were women. Program directors' total annual salary, measured in $25,000 increments, ranged from $75,000 or less to more than $400,000. Historical trends of mode salary by gender from 2008 to 2012 were assessed. The mode salary was $200,000 to 225,000 for men and $175,000 to $200,000 for women (P = .0005). After controlling for academic rank, career in general internal medicine, and program director age, the distribution of salary remained different by gender (P = .004). Historical trends show that the difference in mode salary has persisted since 2008. Leaders in academic medical centers, residency and fellowship directors, and all faculty in medical education need to be aware that salary disparities cited decades ago persist in this sample of medical educators. Closing the gender gap will require continued advocacy for measuring and reporting salary gaps, and changing the culture of academic medical centers. Copyright © 2015 Alliance for Academic Internal Medicine. Published by Elsevier Inc. All rights reserved.

  17. Intern as Patient: A Patient Experience Simulation to Cultivate Empathy in Emergency Medicine Residents

    Directory of Open Access Journals (Sweden)

    Sara W. Nelson

    2017-12-01

    Full Text Available Introduction Prior work links empathy and positive physician-patient relationships to improved healthcare outcomes. The objective of this study was to analyze a patient experience simulation for emergency medicine (EM interns as a way to teach empathy and conscientious patient care. Methods We conducted a qualitative descriptive study on an in situ, patient experience simulation held during EM residency orientation. Half the interns were patients brought into the emergency department (ED by ambulance and half were family members. Interns then took part in focus groups that discussed the experience. Data collected during these focus groups were coded by two investigators using a grounded theory approach and constant comparative methodology. Results We identified 10 major themes and 28 subthemes in the resulting qualitative data. Themes were in three broad categories: the experience as a patient or family member in the ED; application to current clinical practice; and evaluation of the exercise itself. Interns experienced firsthand the physical discomfort, emotional stress and confusion patients and families endure during the ED care process. They reflected on lessons learned, including the importance of good communication skills, frequent updates on care and timing, and being responsive to the needs and concerns of patients and families. All interns felt this was a valuable orientation experience. Conclusion Conducting a patient experience simulation may be a practical and effective way to develop empathy in EM resident physicians. Additional research evaluating the effect of participation in the simulation over a longer time period and assessing the effects on residents’ actual clinical care is warranted.

  18. Communication received on 25 April 1995 from the Resident Representative of Belarus to the International Atomic Energy Agency

    International Nuclear Information System (INIS)

    1995-01-01

    On 25 April 1995, the Director General received a letter from the Resident Representative of Belarus to the International Atomic Energy Agency submitting the official notification of the signing of Belarus of the Agreement between the Republic of Belarus and the Agency for the Application of Safeguards pursuant to the Treaty on the Non-Proliferation of Nuclear Weapons. At the request of the Resident Representative, the text of the attached notification is circulated for the information of Member States

  19. Changes in medicine: residency

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2011-07-01

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

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

    Science.gov (United States)

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

    2009-06-01

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

  1. Request by the Resident Representative of Iraq to the International Atomic Energy Agency

    International Nuclear Information System (INIS)

    1984-09-01

    The document includes three attachments: the letter of 3 May 1984 from the Director General of the IAEA to the Resident Representative of Iraq, the letter of 10 May 1984 to the Director General of the IAEA from the Resident Representative of Iraq and the summary record of discussion in the Board of Governors on 5 June 1984 at its 619th meeting concerning item 20 of the provisional agenda ''Military attack on Iran's Bushehr Nuclear Power Plant''

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

    Directory of Open Access Journals (Sweden)

    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

  3. Resident fatigue in otolaryngology residents: a Web based survey.

    Science.gov (United States)

    Nida, Andrew M; Googe, Benjamin J; Lewis, Andrea F; May, Warren L

    2016-01-01

    Resident fatigue has become a point of emphasis in medical education and its effects on otolaryngology residents and their patients require further study. The purpose of our study was to evaluate the prevalence and nature of fatigue in otolaryngology residents, evaluate various quality of life measures, and investigate associations of increased fatigue with resident safety. Anonymous survey. Internet based. United States allopathic otolaryngology residents. None. The survey topics included demographics, residency structure, sleep habits and perceived stress. Responses were correlated with a concurrent Epworth Sleep Scale questionnaire to evaluate effects of fatigue on resident training and quality of life. 190 residents responded to the survey with 178 completing the Epworth Sleep Scale questionnaire. Results revealed a mean Epworth Sleep Scale score of 9.9±5.1 with a median of 10.0 indicating a significant number of otolaryngology residents are excessively sleepy. Statistically significant correlations between Epworth Sleep Scale and sex, region, hours of sleep, and work hours were found. Residents taking in-house call had significantly fewer hours of sleep compared to home call (p=0.01). Residents on "head and neck" (typically consisting of a large proportion of head and neck oncologic surgery) rotations tended to have higher Epworth Sleep Scale and had significantly fewer hours of sleep (p=.003) and greater work hours (potolaryngology residents are excessively sleepy. Our data suggest that the effects of fatigue play a role in resident well-being and resident safety. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2010-09-01

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

  5. 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.

  6. 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.

  7. Creating a Culture of Wellness in Residency.

    Science.gov (United States)

    Edmondson, Emma K; Kumar, Anupam A; Smith, Stephanie M

    2018-04-17

    Despite increased awareness and recognition of the prevalence of physician burnout and the associated risks of depression and suicide, there is a paucity of actionable guidelines for residency programs to mitigate these risks for their residents. In this Invited Commentary, the authors acknowledge that, although there are inherent barriers to resident wellness, there are numerous modifiable barriers that present opportunities for programs to enable culture change and improve resident wellbeing. The authors frame the discussion with a personal narrative written by a resident in their internal medicine program who experienced burnout, depression, and suicidality during his intern year. They aim to inspire residency programs and hospital leadership to identify and intervene upon the modifiable barriers to wellness for residents in their programs in order to shape meaningful cultural change.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

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

    2011-02-01

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

  10. Leadership Training in Otolaryngology Residency.

    Science.gov (United States)

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

    2017-06-01

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

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

    Science.gov (United States)

    Sawatsky, Adam P; Ratelle, John T; Bonnes, Sara L; Egginton, Jason S; Beckman, Thomas J

    2017-02-02

    Existing theories of self-directed learning (SDL) have emphasized the importance of process, personal, and contextual factors. Previous medical education research has largely focused on the process of SDL. We explored the experience with and perception of SDL among internal medicine residents to gain understanding of the personal and contextual factors of SDL in graduate medical education. Using a constructivist grounded theory approach, we conducted 7 focus group interviews with 46 internal medicine residents at an academic medical center. We processed the data by using open coding and writing analytic memos. Team members organized open codes to create axial codes, which were applied to all transcripts. Guided by a previous model of SDL, we developed a theoretical model that was revised through constant comparison with new data as they were collected, and we refined the theory until it had adequate explanatory power and was appropriately grounded in the experiences of residents. We developed a theoretical model of SDL to explain the process, personal, and contextual factors affecting SDL during residency training. The process of SDL began with a trigger that uncovered a knowledge gap. Residents progressed to formulating learning objectives, using resources, applying knowledge, and evaluating learning. Personal factors included motivations, individual characteristics, and the change in approach to SDL over time. Contextual factors included the need for external guidance, the influence of residency program structure and culture, and the presence of contextual barriers. We developed a theoretical model of SDL in medical education that can be used to promote and assess resident SDL through understanding the process, person, and context of SDL.

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

    Science.gov (United States)

    Choe, John H; Knight, Christopher L; Stiling, Rebekah; Corning, Kelli; Lock, Keli; Steinberg, Kenneth P

    2016-07-01

    The Next Accreditation System requires internal medicine training programs to provide the Accreditation Council for Graduate Medical Education (ACGME) with semiannual information about each resident's progress in 22 subcompetency domains. Evaluation of resident "trustworthiness" in performing entrustable professional activities (EPAs) may offer a more tangible assessment construct than evaluations based on expectations of usual progression toward competence. However, translating results from EPA-based evaluations into ACGME milestone progress reports has proven to be challenging because the constructs that underlay these two systems differ.The authors describe a process to bridge the gap between rotation-specific EPA-based evaluations and ACGME milestone reporting. Developed at the University of Washington in 2012 and 2013, this method involves mapping EPA-based evaluation responses to "milestone elements," the narrative descriptions within the columns of each of the 22 internal medicine subcompetencies. As faculty members complete EPA-based evaluations, the mapped milestone elements are automatically marked as "confirmed." Programs can maintain a database that tallies the number of times each milestone element is confirmed for a resident; these data can be used to produce graphical displays of resident progress along the internal medicine milestones.Using this count of milestone elements allows programs to bridge the gap between faculty assessments of residents based on rotation-specific observed activities and semiannual ACGME reports based on the internal medicine milestones. Although potentially useful for all programs, this method is especially beneficial to large programs where clinical competency committee members may not have the opportunity for direct observation of all residents.

  13. Peer observation and feedback of resident teaching.

    Science.gov (United States)

    Snydman, Laura; Chandler, Daniel; Rencic, Joseph; Sung, Yung-Chi

    2013-02-01

    Resident doctors (residents) play a significant role in the education of medical students. Morning work rounds provide an optimal venue to assess resident teaching. The purpose of this study was to assess the feasibility of peer observation of resident work rounds, to evaluate resident perceptions of peer observation and to evaluate resident perceptions of peer feedback.   Twenty-four internal medicine residents were simultaneously observed by an attending physician and a peer while teaching during work rounds (between August2008 and May 2009). At year-end, residents received a survey to characterise their attitudes towards peer observation and feedback. Twenty-one residents (87.5%) completed the survey. Half (52.4%) felt that participating in the peer observation study stimulated their interest in teaching during work rounds. Prior to participation in the study, fewer than half (42.9%) felt comfortable being observed by their peers, compared with 71.4 percent after participation (p=0.02). The proportion of residents who felt comfortable giving feedback to peers increased from 26.3 to 65.0percent (p=0.004), and the proportion of residents who felt comfortable receiving feedback from peers increased from 76.2 to 95.2 percent (p=0.02). Peer observation and feedback of resident teaching during work rounds is feasible and rewarding for the residents involved. Comfort with regards to being observed by peers, with receiving feedback from peers and with giving feedback to peers significantly increased after the study. Most residents reported changes in their teaching behaviour resulting from feedback. Residents felt that observing a peer teach on work rounds was one of the most useful activities to improve their own teaching on work rounds. © Blackwell Publishing Ltd 2013.

  14. Plagiarism in residency application essays.

    Science.gov (United States)

    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.

  15. Lawful Permanent Residents - Annual Report

    Data.gov (United States)

    Department of Homeland Security — A lawful permanent resident (LPR) or 'green card' recipient is defined by immigration law as a person who has been granted lawful permanent residence in the United...

  16. Operative Landscape at Canadian Neurosurgery Residency Programs.

    Science.gov (United States)

    Tso, Michael K; Dakson, Ayoub; Ahmed, Syed Uzair; Bigder, Mark; Elliott, Cameron; Guha, Daipayan; Iorio-Morin, Christian; Kameda-Smith, Michelle; Lavergne, Pascal; Makarenko, Serge; Taccone, Michael S; Wang, Bill; Winkler-Schwartz, Alexander; Sankar, Tejas; Christie, Sean D

    2017-07-01

    Background Currently, the literature lacks reliable data regarding operative case volumes at Canadian neurosurgery residency programs. Our objective was to provide a snapshot of the operative landscape in Canadian neurosurgical training using the trainee-led Canadian Neurosurgery Research Collaborative. Anonymized administrative operative data were gathered from each neurosurgery residency program from January 1, 2014, to December 31, 2014. Procedures were broadly classified into cranial, spine, peripheral nerve, and miscellaneous procedures. A number of prespecified subspecialty procedures were recorded. We defined the resident case index as the ratio of the total number of operations to the total number of neurosurgery residents in that program. Resident number included both Canadian medical and international medical graduates, and included residents on the neurosurgery service, off-service, or on leave for research or other personal reasons. Overall, there was an average of 1845 operative cases per neurosurgery residency program. The mean numbers of cranial, spine, peripheral nerve, and miscellaneous procedures were 725, 466, 48, and 193, respectively. The nationwide mean resident case indices for cranial, spine, peripheral nerve, and total procedures were 90, 58, 5, and 196, respectively. There was some variation in the resident case indices for specific subspecialty procedures, with some training programs not performing carotid endarterectomy or endoscopic transsphenoidal procedures. This study presents the breadth of neurosurgical training within Canadian neurosurgery residency programs. These results may help inform the implementation of neurosurgery training as the Royal College of Physicians and Surgeons residency training transitions to a competence-by-design curriculum.

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

    Directory of Open Access Journals (Sweden)

    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

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

    Science.gov (United States)

    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

  19. The Impact of 2011 ACGME Duty Hour Restrictions on Internal Medicine Resident Workload and Education

    Science.gov (United States)

    Vucicevic, Darko; Mookadam, Farouk; Webb, Brandon J.; Labonte, Helene R.; Cha, Stephen S.; Blair, Janis E.

    2015-01-01

    The Accreditation Council for Graduate Medical Education (ACGME) implemented work hour restrictions for physicians in training in 2003 that were revised July 1, 2011. Current published data are insufficient to assess whether such work hour restrictions will have long-term impact on residents' education. We searched computer-generated reports…

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

    Science.gov (United States)

    Norcini, John J.; And Others

    1991-01-01

    A study assessed the effectiveness of medical resident training programs during 1983-88 by evaluating students' certification scores and comparing them to the program's evaluation of students' clinical competence. Results are reported and analyzed for top-rated, university-affiliated, and non-university-affiliated programs, focusing on trends over…

  1. Improved competence after a palliative care course for internal medicine residents

    NARCIS (Netherlands)

    Mulder, S. F.; Bleijenberg, G.; Verhagen, S. C.; Stuyt, P. M. J.; Schijven, M. P.; Tack, C. J.

    2009-01-01

    Residents report that they received inadequate teaching in palliative care and low levels of comfort and skills when taking care of dying patients. This study describes the effects of a problem-based palliative care course on perceived competence and knowledge in a representative Dutch cohort of

  2. Resident Advisor General Intelligence, Emotional Intelligence, Personality Dimensions, and Internal Belief Characteristics as Predictors of Rated Performance

    Science.gov (United States)

    Wu, Max B.; Stemler, Steven

    2008-01-01

    Resident Advisors (RAs) have a significant hand in helping students adjust and thrive in college life. Given the importance of selecting high-performing RAs, this study sought to examine how well various measures of intelligence (e.g., general, emotional) in addition to personality and additional "internal belief" characteristics predict…

  3. When the Reading Room Meets the Team Room: Resident Perspectives From Radiology and Internal Medicine on the Effect of Personal Communication After Implementing a Resident-Led Radiology Rounds.

    Science.gov (United States)

    Klobuka, Andrew J; Lee, John; Buranosky, Raquel; Heller, Matthew

    2018-02-13

    Current radiology and internal medicine (IM) residents have trained to varying degrees depending on program in the post picture archiving and communication systems implementation era and thus have largely missed out on the benefits of in-person, 2-way communication between radiologists and consulting clinicians. The purpose of this study is to broadly explore resident perspectives from these groups on the desire for personal contact between radiologists and referring physicians and the effect of improved contact on clinical practice. A radiology rounds was implemented in which radiology residents travel to the IM teaching service teams to discuss their inpatients and review ordered imaging biweekly. Surveys were given to both cohorts following 9 months of implementation. A total of 23/49 diagnostic radiology (DR) and 72/197 IM residents responded. In all, 83% of DR and 96% of IM residents desired more personal contact between radiologists and clinicians. Of all, 92% of DR residents agree that contact with referring clinicians changes their approach to a study, 96% of IM residents agree that personal contact with a radiologist has changed patient management in a way that they otherwise would not have done having simply read a report, 85% of DR residents report that more clinician contact will improve resource use, and 96% report that it will improve care quality. Furthermore, 99% of IM residents report that increased access to a radiologist would make selecting the most appropriate imaging study easier in various clinical scenarios. A majority of IM residents prefer radiology reports that provide specific next-step recommendations and that include arrows/key-image series. We conclude that the newest generation of physicians is already attuned to the value of a radiologist who plays an active, in-person role in the clinical decision-making process. Copyright © 2018 Elsevier Inc. All rights reserved.

  4. Which characteristics of nursing home residents influence differences in malnutrition prevalence? An international comparison of The Netherlands, Germany and Austria.

    Science.gov (United States)

    van Nie-Visser, Noémi C; Meijers, Judith; Schols, Jos; Lohrmann, Christa; Bartholomeyczik, Sabine; Spreeuwenberg, Marieke; Halfens, Ruud

    2014-03-28

    Prevalence rates of malnutrition vary considerably internationally, partly due to differences in measurement methodology and instruments. In the present study, the same measurement methodology and instruments were used in The Netherlands, Germany and Austria. The aim of the present study was to investigate whether resident characteristics influence possible differences in malnutrition prevalence between countries. The study followed a cross-sectional, multi-centre design that measured malnutrition in nursing home residents from The Netherlands, Germany and Austria. Resident data were gathered using a standardised questionnaire. Malnutrition was operationalised using BMI, unintentional weight loss and nutritional intake. Data were analysed using an association model. The prevalence rates of malnutrition in The Netherlands, Germany and Austria were 18·3, 20·1 and 22·5 %, respectively. The multivariate generalised estimating equation (GEE) logistic regression analysis showed that sex, age, care dependency, the mean number of diseases and some specific diseases were influencing factors for whether the resident was malnourished or not. The OR of malnutrition in the three countries declined after including the influencing factors resulting from the multivariate GEE analysis. The present study reveals that differences in the prevalence rates of malnutrition in nursing homes in The Netherlands, Germany and Austria are influenced by different resident characteristics. Since other country-related factors could also play an important role in influencing differences in the prevalence rates of malnutrition between the countries (structural and process factors of malnutrition care policy). We recommend the investigation of these factors in future studies.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

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

    2017-10-01

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

  7. Resident Peritoneal NK cells

    Science.gov (United States)

    Gonzaga, Rosemary; Matzinger, Polly; Perez-Diez, Ainhoa

    2011-01-01

    Here we describe a new population of NK cells that reside in the normal, un-inflamed peritoneal cavity. Phenotypically, they share some similarities with the small population of CD49b negative, CD27 positive immature splenic NK cells, and liver NK cells but differ in their expression of CD62L, TRAIL and EOMES. Functionally, the peritoneal NK cells resemble the immature splenic NK cells in their production of IFN-γ, GM-CSF and TNF-α and in the killing of YAC-1 target cells. We also found that the peritoneum induces different behavior in mature and immature splenic NK cells. When transferred intravenously into RAGγcKO mice, both populations undergo homeostatic proliferation in the spleen, but only the immature splenic NK cells, are able to reach the peritoneum. When transferred directly into the peritoneum, the mature NK cells survive but do not divide, while the immature NK cells proliferate profusely. These data suggest that the peritoneum is not only home to a new subset of tissue resident NK cells but that it differentially regulates the migration and homeostatic proliferation of immature versus mature NK cells. PMID:22079985

  8. Use of a Geriatric Quality Initiative to Educate Internal Medicine Residents about Delirium and Its Risk Factors.

    Science.gov (United States)

    Olveczky, Daniele; Mattison, Melissa L P; Mukamal, Kenneth J

    2013-06-01

    Delirium is a common and debilitating complication of inpatient care for many older adults, yet internal medicine residents often do not recognize delirium or its risk factors. Integrating geriatric education (eg, delirium recognition) with inpatient quality improvement (QI) is not well tested. We developed an educational pilot program within an ongoing hospital-wide geriatric QI initiative (Global Risk Assessment and Careplan for the Elderly-Acute Care [GRACE-AC]). GRACE-AC modifies the inpatient computerized provider order entry system to meet the needs of vulnerable older adults and uses a bedside care checklist to identify patients with possible delirium and promote delirium prevention by checking on the need for "tethers" (intravenous fluids, Foley catheters, and telemetry). Residents were assessed before and after each inpatient rotation by using anonymous electronic surveys. A total of 167 eligible residents (91%) completed prerotation surveys, and 102 (56%) residents completed postrotation surveys. All but the first rotating resident group received a standardized 2-minute educational in-service orientation. In a comparison of postrotation responses before and after implementation of the in-service, the proportion of residents who reported improvement in their ability to recall which patients had tethers increased from 17% to 52% for intravenous fluids (P  =  .004), 28% to 75% for Foley catheters (P < .001), and 21% to 50% for telemetry (P  =  .02). Comparing pre- and postrotation surveys, the proportion of correct responses to questions on haloperidol dosing and the characteristics of delirium increased from 26% to 76% and 31% to 63%, respectively (both P < .001). Our pilot program demonstrated that inpatient geriatric QI initiatives can be successfully merged with a brief educational curriculum.

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

    International Nuclear Information System (INIS)

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

    2012-01-01

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

  10. Migration, foraging, and residency patterns for Northern Gulf loggerheads: implications of local threats and international movements.

    Directory of Open Access Journals (Sweden)

    Kristen M Hart

    Full Text Available Northern Gulf of Mexico (NGoM loggerheads (Caretta caretta make up one of the smallest subpopulations of this threatened species and have declining nest numbers. We used satellite telemetry and a switching state-space model to identify distinct foraging areas used by 59 NGoM loggerheads tagged during 2010-2013. We tagged turtles after nesting at three sites, 1 in Alabama (Gulf Shores; n = 37 and 2 in Florida (St. Joseph Peninsula; n = 20 and Eglin Air Force Base; n = 2. Peak migration time was 22 July to 9 August during which >40% of turtles were in migration mode; the mean post-nesting migration period was 23.0 d (±13.8 d SD. After displacement from nesting beaches, 44 turtles traveled to foraging sites where they remained resident throughout tracking durations. Selected foraging locations were variable distances from tagging sites, and in 5 geographic regions; no turtles selected foraging sites outside the Gulf of Mexico (GoM. Foraging sites delineated using 50% kernel density estimation were located a mean distance of 47.6 km from land and in water with mean depth of -32.5 m; other foraging sites, delineated using minimum convex polygons, were located a mean distance of 43.0 km from land and in water with a mean depth of -24.9 m. Foraging sites overlapped with known trawling activities, oil and gas extraction activities, and the footprint of surface oiling during the 2010 Deepwater Horizon oil spill (n = 10. Our results highlight the year-round use of habitats in the GoM by loggerheads that nest in the NGoM. Our findings indicate that protection of females in this subpopulation requires both international collaborations and management of threats that spatially overlap with distinct foraging habitats.

  11. The pregnant female surgical resident

    Directory of Open Access Journals (Sweden)

    Shifflette V

    2018-05-01

    Full Text Available Vanessa Shifflette,1 Susannah Hambright,2 Joseph Darryl Amos,1 Ernest Dunn,3 Maria Allo4 1Associates in Surgical Acute Care, Methodist Dallas Medical Center, Dallas, TX, USA; 2Methodist Surgical Associates, Methodist Dallas Medical Center, Dallas, TX, USA; 3Graduate Medical Education - General Surgery, Methodist Dallas Medical Center, Dallas, TX, USA; 4Santa Clara Valley Medical Center, San Jose, CA, USA Background: Surgery continues to be an intense, time-consuming residency. Many medical students decide against surgery as a profession due to the long work hours and family strain. The pregnant female surgical resident has an added stress factor compared to her male counterpart. Methods: We distributed an electronic, online 26-question survey to 32 general surgery programs in the southwestern region of the United States. Each program distributed our survey to the female surgical residents who had been pregnant during residency in the last 5 years. Each program was re-contacted 6 weeks after the initial contact. Most questions were in a 5-point Likert scale format. The responses were collected and analyzed using the Survey Monkey website. Results: An unvalidated survey was sent to 32 general surgery programs and 26 programs responded (81%. Each program was asked for the total number of possible responses from female residents that met our criteria (60 female residents. Seven of the programs (27% stated that they have had zero residents pregnant. We had 22 residents respond (37%. Over half of the residents (55% were pregnant during their 2nd or 3rd year of residency, with only 18% pregnant during a research year. Thirty-one percent had a lower American Board of Surgery In-Training Exam (ABSITE score. Ninety percent of the residents were able to take 4 weeks or more for maternity leave. Most of the residents (95% stated that they would do this again during residency given the opportunity, but many of the residents felt that returning back to work

  12. Validity and applicability of the Mini International Neuropsychiatric Interview administered by family medicine residents in primary health care in Brazil.

    Science.gov (United States)

    de Azevedo Marques, João Mazzoncini; Zuardi, Antonio W

    2008-01-01

    To evaluate the validity and applicability of the Mini International Neuropsychiatric Interview (MINI) used by family medicine residents in primary health care (PHC) in Brazil. Training for administrating the MINI was given as part of a broad psychiatry education program. Interviews were held with 120 PHC patients who were at least 15 years old. MINI was administered by 25 resident physicians, while the Structured Clinical Interview for Diagnosis (SCID) was administered by a psychiatrist blind to patients' results on the MINI, and the diagnoses on both interviews were compared. The resident physicians answered questions on the applicability of the MINI. Concordance levels for any mental disorder, the broader current diagnostic categories and the most common specific diagnoses were analyzed. Kappa coefficients ranged between 0.65 and 0.85; sensitivity, between 0.75 and 0.92; specificity, between 0.90 and 0.99; positive predictive values (PPV), between 0.60 and 0.86; negative predictive values (NPV), between 0.92 and 0.99; and accuracy, between 0.88 and 0.98. The resident physicians considered MINI comprehensibility and clinical relevance satisfactory. These good psychometric results in a real-world setting may be related to a special training program, which is more frequent, intensive and diversified. In these conditions, the MINI is a useful tool for general practitioners.

  13. Residents examine factors associated with 30-day, same-cause hospital readmissions on an internal medicine service.

    Science.gov (United States)

    Moran, Jennifer; Colbert, Colleen Y; Song, Juhee; Hull, Joshua; Rajan, Sabitha; Varghees, Sunita; Arroliga, Alejandro C; Reddy, Santosh P

    2013-01-01

    In recent years, there has been increased interest in stemming the tide of hospital readmissions in an attempt to improve quality of care. This study presents the Phase I results of a resident-led quality improvement initiative to determine the percentage of and risk factors for same-cause readmissions (SCRs; defined as hospital readmission within 30 days of hospital discharge for treatment of the same condition) to the internal medicine service of a multispecialty teaching hospital in central Texas. Results indicate that patients diagnosed with chronic obstructive pulmonary disease/asthma or anemia may be at increased risk for SCRs. Those patients who are insured by Medicaid and those who require assistance from social services also demonstrated an increased risk for SCRs. This study appears to be the first resident-led initiative in the field to examine 30-day SCRs to an internal medicine service for demographic and clinical risk factors.

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

    Science.gov (United States)

    Shaverdian, Narek; Yoo, Sun Mi; Cook, Ryan; Chang, Eric M; Jiang, Naomi; Yuan, Ye; Sandler, Kiri; Steinberg, Michael; Lee, Percy

    2017-08-01

    Internists and primary care providers play a growing role in cancer care. We therefore evaluated the awareness of radiation therapy in general and specifically the clinical utility of stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer (NSCLC) among current US internal medicine residents. A web-based institutional review board-approved multi-institutional survey was distributed to US internal medicine residency programs. The survey evaluated trainee demographic characteristics, baseline radiation oncology awareness, knowledge of the role of SBRT for early-stage NSCLC, and whether the survey successfully improved awareness. Thirty US internal medicine programs participated, with an overall participant response rate of 46% (1177 of 2551). Of the trainees, 93% (n=1076) reported no radiation oncology education in their residency, 39% (n=452) reported confidence in knowing when to consult radiation oncology in an oncologic emergency, and 26% (n=293) reported confidence in knowing when to consult radiation oncology in the setting of a newly diagnosed cancer. Of the participants, 76% (n=850) correctly identified that surgical resection is the standard treatment in operable early-stage NSCLC, but only 50% (n=559) of participants would recommend SBRT to a medically inoperable patient, followed by 31% of participants (n=347) who were unsure of the most appropriate treatment, and 10% (n=117) who recommended waiting to offer palliative therapy. Ninety percent of participants (n=1029) agreed that they would benefit from further training on when to consult radiation oncology. Overall, 96% (n=1072) indicated that the survey increased their knowledge and awareness of the role of SBRT. The majority of participating trainees received no education in radiation oncology in their residency, reported a lack of confidence regarding when to consult radiation oncology, and overwhelmingly agreed that they would benefit from further training. These findings

  15. [Medical ethics in residency training].

    Science.gov (United States)

    Civaner, Murat; Sarikaya, Ozlem; Balcioğlu, Harun

    2009-04-01

    Medical ethics education in residency training is one of the hot topics of continuous medical education debates. Its importance and necessity is constantly stressed in declarations and statements on national and international level. Parallel to the major structural changes in the organization and the finance model of health care system, patient-physician relationship, identity of physicianship, social perception and status of profession are changing. Besides, scientific developments and technological advancements create possibilities that never exists before, and bring new ethical dilemmas along with. To be able to transplant human organs has created two major problems for instance; procurement of organs in sufficient numbers, and allocating them to the patients in need by using some prioritizing criteria. All those new and challenging questions force the health care workers to find authentic and justifiable solutions while keeping the basic professional values. In that sense, proper medical ethics education in undergraduate and postgraduate term that would make physician-to-be's and student-physicians acquire the core professional values and skill to notice, analyze and develop justifiable solutions to ethical problems is paramount. This article aims to express the importance of medical ethics education in residency training, and to propose major topics and educational methods to be implemented into. To this aim, first, undergraduate medical education, physician's working conditions, the exam of selection for residency training, and educational environment were revised, and then, some topics and educational methods, which are oriented to educate physicians regarding the professional values that they should have, were proposed.

  16. Education Research: Neurology resident education

    Science.gov (United States)

    Mayans, David; Schneider, Logan; Adams, Nellie; Khawaja, Ayaz M.; Engstrom, John

    2016-01-01

    Objective: To survey US-trained graduating neurology residents who are American Academy of Neurology members, in an effort to trend perceived quality and completeness of graduate neurology education. Methods: An electronic survey was sent to all American Academy of Neurology members graduating from US neurology residency programs in the Spring of 2014. Results: Of 805 eligible respondents, 24% completed the survey. Ninety-three percent of adult neurology residents and 56% of child neurology residents reported plans to pursue fellowship training after residency. Respondents reported a desire for additional training in neurocritical care, neuro-oncology, neuromuscular diseases, botulinum toxin injection, and nerve blocks. There remains a clear deficit in business training of neurology residents, although there was notable improvement in knowledge of coding and office management compared to previous surveys. Discussion: Although there are still areas of perceived weakness in neurology training, graduating neurology residents feel generally well prepared for their chosen careers. However, most still pursue fellowship training for reasons that are little understood. In addition to certain subspecialties and procedures, practice management remains deficient in neurology training and is a point of future insecurity for most residents. Future curriculum changes should consider resident-reported gaps in knowledge, with careful consideration of improving business training. PMID:26976522

  17. Young and burnt? Italian contribution to the international BurnOut Syndrome Study (BOSS) among residents in psychiatry.

    Science.gov (United States)

    Ferrari, Silvia; Cuoghi, Giulia; Mattei, Giorgio; Carra, Elena; Volpe, Umberto; Jovanovic, Nikolina; Beezhold, J; Rigatelli, Marco; Galeazzi, Gian Maria; Pingani, Luca

    2015-05-04

    The Burnout Syndrome (BS) is a common condition among health care professionals, yet data concerning its prevalence and associated factors among psychiatric residents are lacking. To report the results of the Italian contribution to "BOSS", an international multicentre research project aiming at estimating the burden of BS among residents in psychiatry, and at identifying factors contributing to its development and prevention. Cross-sectional study. The BOSS online questionnaire, which collected socio-demographic data and five psychometric tools (MBI-GS, AWLS, PHQ-9, SIBQ, BFI), was administered electronically to 180 Italian residents in psychiatry. Simple and multiple linear regressions were performed to analyse data. 108 questionnaires provided data for the study (response rate: 60%). Mean age: 30.5 ± 3.7 years. Eighty percent of the sample were female. A moderate level of BS emerged, related to work conditions, absence of major depression, satisfaction with pay or less academic activity. Only 0.9% (N=1) of the sample showed PHQ-9 scores suggestive of major depression, while lifetime suicidal ideation was admitted by 16% of residents. For the three dimensions of the MBI-GS, Italian sample scores were consistent with previously published results concerning pooled data in a French-Croatian sample, reporting moderate levels of BS. Higher workload, symptoms of depression and lower satisfaction predicted higher levels of Emotional Exhaustion and Cynicism. Italian residents in psychiatry showed overall moderate levels of BS, related to workload and work organization. Other alerts of psychic distress were found among participants, namely symptoms of depression, suicidal ideation and use of psychotropic medications.

  18. Using an Inpatient Quality Improvement Curriculum for Internal Medicine Residents to Improve Pneumococcal Conjugate Vaccine Administration Rates.

    Science.gov (United States)

    Jolin, Jonathan; van Aalst, Robertus; Volpp, Bryan; Taylor, Thomas; Cohen, Emily

    2018-06-01

    Pneumococcal infections are an important source of morbidity and mortality in older adults and persons with compromised immune systems. New recommendations from the Advisory Committee on Immunization Practices (ACIP) became available September 2014, which included recommendations for the use of the 13-valent pneumococcal conjugate vaccine (PCV13). A study was conducted to increase the PCV13 vaccination rates of hospitalized patients at the White River Junction Veterans Affairs Medical Center (White River Junction, Vermont) through the use of a resident-driven quality improvement (QI) project. From December 2014 through April 2016, 16 internal medicine inpatient residents addressed inpatient PCV13 vaccination rates by participating in the facility's QI curriculum. Eight Plan-Do-Study-Act cycles were used, including discharge template editing, electronic reminders, and the discovery of a vaccination administration documentation error in the record through data validation. The measure was the monthly percentage of patients who received PCV13 vaccination (vaccination completion rate) of those discharged from the hospital medicine service who were due for PCV13 vaccination. The percentage of veterans discharged with an up-to-date PCV13 vaccination on discharge increased from approximately 30% to 87% and was sustained. Despite being driven by many different residents, this project demonstrates that continuous improvement can be achieved through a structured and iterative process while providing active learning of core QI concepts to residents. It also displays a method in which new guidelines can be incorporated into practice in an effective manner. Finally, this project is an example of how resident-driven data validation can lead to further improvement. Published by Elsevier Inc.

  19. Introducing routine HIV screening for patients on an internal medicine residency inpatient service: a quality improvement project.

    Science.gov (United States)

    Padrnos, Leslie J; Barr, Patrick J; Klassen, Christine L; Fields, Heather E; Azadeh, Natalya; Mendoza, Neil; Saadiq, Rayya A; Pauwels, Emanuel M; King, Christopher S; Chung, Andrew A; Sakata, Kenneth K; Blair, Janis E

    2016-01-01

    The US Centers for Disease Control and Prevention (CDC) recommend human immunodeficiency virus (HIV) screening for all persons aged 13 to 64 years who present to a health care provider. We sought to improve adherence to the CDC guidelines on the Internal Medicine Resident Hospital Service. We surveyed residents about the CDC guidelines, sent email reminders, provided education, and engaged them in friendly competition. Credit for guideline adherence was awarded if an offer of HIV screening was documented at admission, if a screening test was performed, or if a notation in the resident sign out sheet indicated why screening was not performed. We examined HIV screening of a postintervention group of patients admitted between August 8, 2012, and June 30, 2013, and compared them to a preintervention group admitted between August 1, 2011, and June 30, 2012. Postintervention offers of HIV screening increased significantly (7.9% [44/559] vs 55.5% [300/541]; P<.001), as did documentation of residents' contemplation of screening (8.9% [50/559] vs 67.5% [365/541]; P<.001). A significantly higher proportion of HIV screening tests was ordered postintervention (7.7% [43/559] vs 44.4% [240/541]; P<.001). Monthly HIV screening documentation ranged from 0% (0/53) to 17% (9/53) preintervention, whereas it ranged from 30.6% (11/36) to 100% (62/62) postintervention. HIV screening adherence can be improved through resident education, friendly competition, and system reminders. Barriers to achieving sustained adherence to the CDC guidelines include a heterogeneous patient population and provider discomfort with the subject.

  20. 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.

  1. DIFFICULTIES IN INTERNATIONAL TRAVELLING FOR RESIDENTS OF AREAS WITH UNDEFINED POLITICAL STATUS. CASE STUDY: CRIMEA

    Directory of Open Access Journals (Sweden)

    Ștefan Constantin

    2016-05-01

    Full Text Available In March 2014 a change took place on Europe's political map. The Crimean Peninsula became part of Russia, switching sovereignty after more than 20 years during which it was part of Ukraine. This took place following a Russian military intervention and a referendum. A majority of the world's countries however, do not recognize the Russian control of Crimea and still consider it a part of Ukraine, rendering the territory an area with undefined political status. Shortly after the sovereignty change, the region and its population started experiencing all kinds of hardships. An often neglected type of hardship Crimeans are experiencing is the difficulty of obtaining visas. Following the referendum, many diplomatic missions in Russia have instituted a policy of not issuing visas to residents of Crimea who apply with Russian-issued documents. This article shall make a summary of EU and Schengen countries' positions regarding this issue, as these are the biggest groups of countries that requires both Russians and Ukrainians to obtain visas before travelling there. This research was made mostly directly, by requesting each country's diplomatic mission in Moscow to give an official position. The research had the purpose of verifying the information that certain countries do issue visas to Crimeans with Russian documents and also to give a more general and complex picture on the matter of visas for residents of Crimea. This theme is important as a policy of not issuing visas has significant repercussions on the region's economy and on the freedom of movement of its citizens.

  2. Communication dated 1 June 2011 from the Resident Representative of Japan to the Agency regarding an International Conference on Nuclear Safety

    International Nuclear Information System (INIS)

    2011-01-01

    The Director General has received a letter dated 1 June 2011 from the Resident Representative of Japan to the Agency concerning Japan's intention to organize an international conference, during the latter half of 2012, on nuclear safety in cooperation with the IAEA. As requested by the Resident Representative of Japan, the letter is circulated herewith for information of all Member States [es

  3. Communication dated 1 June 2011 from the Resident Representative of Japan to the Agency regarding an International Conference on Nuclear Safety

    International Nuclear Information System (INIS)

    2011-01-01

    The Director General has received a letter dated 1 June 2011 from the Resident Representative of Japan to the Agency concerning Japan's intention to organize an international conference, during the latter half of 2012, on nuclear safety in cooperation with the IAEA. As requested by the Resident Representative of Japan, the letter is circulated herewith for information of all Member States [fr

  4. 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

  5. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  7. Contemporary Trends in Radiation Oncology Resident Research

    International Nuclear Information System (INIS)

    Verma, Vivek; Burt, Lindsay; Gimotty, Phyllis A.; Ojerholm, Eric

    2016-01-01

    Purpose: To test the hypothesis that recent resident research productivity might be different than a decade ago, and to provide contemporary information about resident scholarly activity. Methods and Materials: We compiled a list of radiation oncology residents from the 2 most recent graduating classes (June 2014 and 2015) using the Association of Residents in Radiation Oncology annual directories. We queried the PubMed database for each resident's first-authored publications from postgraduate years (PGY) 2 through 5, plus a 3-month period after residency completion. We abstracted corresponding historical data for 2002 to 2007 from the benchmark publication by Morgan and colleagues (Int J Radiat Oncol Biol Phys 2009;74:1567-1572). We tested the null hypothesis that these 2 samples had the same distribution for number of publications using the Wilcoxon rank-sum test. We explored the association of demographic factors and publication number using multivariable zero-inflated Poisson regression. Results: There were 334 residents publishing 659 eligible first-author publications during residency (range 0-17; interquartile range 0-3; mean 2.0; median 1). The contemporary and historical distributions were significantly different (P<.001); contemporary publication rates were higher. Publications accrued late in residency (27% in PGY-4, 59% in PGY-5), and most were original research (75%). In the historical cohort, half of all articles were published in 3 journals; in contrast, the top half of contemporary publications were spread over 10 journals—most commonly International Journal of Radiation Oncology • Biology • Physics (17%), Practical Radiation Oncology (7%), and Radiation Oncology (4%). Male gender, non-PhD status, and larger residency size were associated with higher number of publications in the multivariable analysis. Conclusion: We observed an increase in first-author publications during training compared with historical data from the mid-2000s. These

  8. Contemporary Trends in Radiation Oncology Resident Research

    Energy Technology Data Exchange (ETDEWEB)

    Verma, Vivek [Department of Radiation Oncology, University of Nebraska, Omaha, Nebraska (United States); Burt, Lindsay [Department of Radiation Oncology, University of Utah, Salt Lake City, Utah (United States); Gimotty, Phyllis A. [Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Ojerholm, Eric, E-mail: eric.ojerholm@uphs.upenn.edu [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States)

    2016-11-15

    Purpose: To test the hypothesis that recent resident research productivity might be different than a decade ago, and to provide contemporary information about resident scholarly activity. Methods and Materials: We compiled a list of radiation oncology residents from the 2 most recent graduating classes (June 2014 and 2015) using the Association of Residents in Radiation Oncology annual directories. We queried the PubMed database for each resident's first-authored publications from postgraduate years (PGY) 2 through 5, plus a 3-month period after residency completion. We abstracted corresponding historical data for 2002 to 2007 from the benchmark publication by Morgan and colleagues (Int J Radiat Oncol Biol Phys 2009;74:1567-1572). We tested the null hypothesis that these 2 samples had the same distribution for number of publications using the Wilcoxon rank-sum test. We explored the association of demographic factors and publication number using multivariable zero-inflated Poisson regression. Results: There were 334 residents publishing 659 eligible first-author publications during residency (range 0-17; interquartile range 0-3; mean 2.0; median 1). The contemporary and historical distributions were significantly different (P<.001); contemporary publication rates were higher. Publications accrued late in residency (27% in PGY-4, 59% in PGY-5), and most were original research (75%). In the historical cohort, half of all articles were published in 3 journals; in contrast, the top half of contemporary publications were spread over 10 journals—most commonly International Journal of Radiation Oncology • Biology • Physics (17%), Practical Radiation Oncology (7%), and Radiation Oncology (4%). Male gender, non-PhD status, and larger residency size were associated with higher number of publications in the multivariable analysis. Conclusion: We observed an increase in first-author publications during training compared with historical data from the mid-2000s. These

  9. Surgical residency: A tenant's view

    African Journals Online (AJOL)

    'To sleep: perchance to dream', is the frequent mantra of the surgical resident. However, unlike. Hamlet, there is no ensuing speculation as to what dreams may come as there are seldom any!! Surgical residency has been both vilified and immortalized, but the fact remains that it is one of the most challenging, provocative ...

  10. 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

  11. Postgraduate internal medicine residents' roles at patient discharge - do their perceived roles and perceptions by other health care providers correlate?

    Science.gov (United States)

    Card, Sharon Elizabeth; Ward, Heather A; Chipperfield, Dylan; Sheppard, M Suzanne

    2014-01-01

    Knowing one's own role is a key collaboration competency for postgraduate trainees in the Canadian competency framework (CanMEDS®). To explore methods to teach collaborative competency to internal medicine postgraduate trainees, baseline role knowledge of the trainees was explored. The perceptions of roles (self and others) at patient discharge from an acute care internal medicine teaching unit amongst 69 participants, 34 physicians (25 internal medicine postgraduate trainees and 9 faculty physicians) and 35 health care professionals from different professions were assessed using an adapted previously validated survey (Jenkins et al., 2001). Internal medicine postgraduate trainees agreed on 8/13 (62%) discharge roles, but for 5/13 (38%), there was a substantial disagreement. Other professions had similar lack of clarity about the postgraduate internal medicine residents' roles at discharge. The lack of interprofessional and intraprofessional clarity about roles needs to be explored to develop methods to enhance collaborative competence in internal medicine postgraduate trainees.

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

    Science.gov (United States)

    Sabath, Bruce F; Singh, Gurkeerat

    2016-01-01

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

  13. Early resident-to-resident physics education in diagnostic radiology.

    Science.gov (United States)

    Kansagra, Akash P

    2014-01-01

    The revised ABR board certification process has updated the method by which diagnostic radiology residents are evaluated for competency in clinical radiologic physics. In this work, the author reports the successful design and implementation of a resident-taught physics course consisting of 5 weekly, hour-long lectures intended for incoming first-year radiology residents in their first month of training. To the author's knowledge, this is the first description of a course designed to provide a very early framework for ongoing physics education throughout residency without increasing the didactic burden on faculty members. Twenty-six first-year residents spanning 2 academic years took the course and reported subjective improvement in their knowledge (90%) and interest (75%) in imaging physics and a high level of satisfaction with the use of senior residents as physics educators. Based on the success of this course and the minimal resources required for implementation, this work may serve as a blueprint for other radiology residency programs seeking to develop revised physics curricula. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  14. Needs Assessment for Incoming PGY-1 Residents in Neurosurgical Residency.

    Science.gov (United States)

    Brandman, David M; Haji, Faizal A; Matte, Marie C; Clarke, David B

    2015-01-01

    Residents must develop a diverse range of skills in order to practice neurosurgery safely and effectively. The purpose of this study was to identify the foundational skills required for neurosurgical trainees as they transition from medical school to residency. Based on the CanMEDS competency framework, a web-based survey was distributed to all Canadian academic neurosurgical centers, targeting incoming and current PGY-1 neurosurgical residents as well as program directors. Using Likert scale and free-text responses, respondents rated the importance of various cognitive (e.g. management of raised intracranial pressure), technical (e.g. performing a lumbar puncture) and behavioral skills (e.g. obtaining informed consent) required for a PGY-1 neurosurgical resident. Of 52 individuals contacted, 38 responses were received. Of these, 10 were from program directors (71%), 11 from current PGY-1 residents (58%) and 17 from incoming PGY-1 residents (89%). Respondents emphasized operative skills such as proper sterile technique and patient positioning; clinical skills such as lesion localization and interpreting neuro-imaging; management skills for common scenarios such as raised intracranial pressure and status epilepticus; and technical skills such as lumbar puncture and external ventricular drain placement. Free text answers were concordant with the Likert scale results. We surveyed Canadian neurosurgical program directors and PGY-1 residents to identify areas perceived as foundational to neurosurgical residency education and training. This information is valuable for evaluating the appropriateness of a training program's goals and objectives, as well as for generating a national educational curriculum for incoming PGY-1 residents.

  15. Psychiatry residents in a milieu participatory democracy: a resident's view.

    Science.gov (United States)

    Gersten, D

    1978-11-01

    Psychiatry residents respond with a variety of coping mechanisms to the lack of traditional structure in a milieu participatory democracy. To incorporate themselves into the system they must accept such democratic ideals as equality among staff and patients, group decision making, and free self-expression and give up some of their traditional ideas about staff and patient roles, treatment modalities, and the therapeutic environment. The author was a first-year resident in psychiatry on a university hospital inpatient therapeutic community; he discusses the conflicts between residents, who often adopt a "we-they" attitude, and the permanent staff, whose protectiveness of the ward community reflects their personal commitment to its ideals.

  16. Does Residency Selection Criteria Predict Performance in Orthopaedic Surgery Residency?

    Science.gov (United States)

    Raman, Tina; Alrabaa, Rami George; Sood, Amit; Maloof, Paul; Benevenia, Joseph; Berberian, Wayne

    2016-04-01

    More than 1000 candidates applied for orthopaedic residency positions in 2014, and the competition is intense; approximately one-third of the candidates failed to secure a position in the match. However, the criteria used in the selection process often are subjective and studies have differed in terms of which criteria predict either objective measures or subjective ratings of resident performance by faculty. Do preresidency selection factors serve as predictors of success in residency? Specifically, we asked which preresidency selection factors are associated or correlated with (1) objective measures of resident knowledge and performance; and (2) subjective ratings by faculty. Charts of 60 orthopaedic residents from our institution were reviewed. Preresidency selection criteria examined included United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores, Medical College Admission Test (MCAT) scores, number of clinical clerkship honors, number of letters of recommendation, number of away rotations, Alpha Omega Alpha (AOA) honor medical society membership, fourth-year subinternship at our institution, and number of publications. Resident performance was assessed using objective measures including American Board of Orthopaedic Surgery (ABOS) Part I scores and Orthopaedics In-Training Exam (OITE) scores and subjective ratings by faculty including global evaluation scores and faculty rankings of residents. We tested associations between preresidency criteria and the subsequent objective and subjective metrics using linear correlation analysis and Mann-Whitney tests when appropriate. Objective measures of resident performance namely, ABOS Part I scores, had a moderate linear correlation with the USMLE Step 2 scores (r = 0.55, p communication skills" subsection of the global evaluations. We found that USMLE Step 2, number of honors in medical school clerkships, and AOA membership demonstrated the strongest correlations with resident performance. Our

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2018-04-01

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

  19. Relationship of residency program characteristics with pass rate of the American Board of Internal Medicine certifying exam

    Directory of Open Access Journals (Sweden)

    Amporn Atsawarungruangkit

    2015-09-01

    Full Text Available Objectives: To evaluate the relationship between the pass rate of the American Board of Internal Medicine (ABIM certifying exam and the characteristics of residency programs. Methods: The study used a retrospective, cross-sectional design with publicly available data from the ABIM and the Fellowship and Residency Electronic Interactive Database. All categorical residency programs with reported pass rates were included. Using univariate and multivariate, linear regression analyses, I analyzed how 69 factors (e.g., location, general information, number of faculty and trainees, work schedule, educational environment are related to the pass rate. Results: Of 371 programs, only one region had a significantly different pass rate from the other regions; however, as no other characteristics were reported in this region, I excluded program location from further analysis. In the multivariate analysis, pass rate was significantly associated with four program characteristics: ratio of full-time equivalent paid faculty to positions, percentage of osteopathic doctors, formal mentoring program, and on-site child care (OCC. Numerous factors were not associated at all, including minimum exam scores, salary, vacation days, and average hours per week. Conclusions: As shown through the ratio of full-time equivalent paid faculty to positions and whether there was a formal mentoring program, a highly supervised training experience was strongly associated with the pass rate. In contrast, percentage of osteopathic doctors was inversely related to the pass rate. Programs with OCC significantly outperformed programs without OCC. This study suggested that enhancing supervision of training programs and offering parental support may help attract and produce competitive residents.

  20. Evaluation of 222Rn concentration of the internal and external environments of residences at Monte Alegre municipality, Para, Brazil

    International Nuclear Information System (INIS)

    Melo, Vicente de Paula

    1999-01-01

    The human being is constantly exposed to the natural radioactivity in the environment where he lives. This radioactivity comes mainly from materials present in the terrestrial crust that possess in their constitution chemical elements belonging to the radioactive families of uranium and thorium. The use of such materials for the construction of houses constitutes an important exposure form to the natural radiation, above all to the radioactive gas 222 Rn, that it is exhaled from them. The Brazilian soil is composed, among other, of minerals that contain appreciable concentrations of these elements. The inhabitants of Monte Alegre town in Para, located at 2 deg 00' 24,9 'S ; 54 deg 04 ' 13,5 W , used in the construction of their houses stones obtained from an area 20 km distant of Monte Alegre, denominated Ingles de Souza, located at 01 deg 56' 4 0,1 S; 54 deg 12 149,7 W, where a small residential village, denominated National Agricultural Colony of Para (CANP), is located. The objective of this work was to evaluate the indoor concentration of 222 Rn in the residences of Monte Alegre and CANP. Determinations of the 238 U and 226 Ra concentrations, measurements of the radon flux in samples of stones and soils of the two regions, as well as measurements to the gamma dose close of the soil and inside the residences, were also carried out. The average results of the radon concentration in the air of the investigated residences did not exceed the limits of 200 Bq. m 3 (action level) and 600 Bq. m 3 (intervention level) recommended by the International Commission on Radiological Protection (ICRP). The concentrations of natural radionuclides and the radon flux determined at the village showed values 17 times higher than those found at the urban area of Monte Alegre, while the average indoor gamma dose rate in the village residences was 0.86 mSv/a. (author)

  1. Personal finances of urology residents in Canada.

    Science.gov (United States)

    Teichman, J M; Tongco, W; MacNeily, A E; Smart, M

    2000-12-01

    We examined how Urology residents in Canada manage their personal finances. A survey instrument was designed to elicit information on demographics, expenses, savings and incomes. The questionnaire was completed by 40 Urology residents attending the 2000 Queen's Urology Exam Skills Training (QUEST) program. Twenty-eight residents (70%) had educational debt (median debt $50 000). Seventeen residents (45%) paid credit card interest charges within the last year. Four residents (10%) maintained an unpaid credit card balance > $7500 at 17% annual interest rate. Twenty-six residents (67%) contributed to Registered Retirement Savings Program (RRSP) accounts. Seventeen residents (44%) contributed to non-RRSP retirement accounts. Nineteen residents (50%) budgeted expenses. Median resident income was $45 000. Thirteen residents (34%) had cash reserves < $250. Many residents save little, and incur substantial debt over and above educational loans. Many residents would benefit from instruction concerning prudent financial management. Residents should be informed of the consequences of low saving and high debt.

  2. Resident Wellness and Social Support: Development and Cognitive Validation of a Resident Social Capital Assessment Tool.

    Science.gov (United States)

    Kaplan, Stephen J; Seabott, Heather M; Cunningham, Erika B; Helman, James D; Calderon, Alvin; Thirlby, Richard C; Schenarts, Kimberly D

    The purpose of this study is to develop and generate validity evidence for an instrument to measure social capital in residents. Mixed-methods, phased approach utilizing a modified Delphi technique, focus groups, and cognitive interviews. Four residency training institutions in Washington state between February 2016 and March 2017. General surgery, anesthesia, and internal medicine residents ranging from PGY-1 to PGY-6. The initial resident-focused instrument underwent revision via Delphi process with 6 experts; 100% expert consensus was achieved after 4 cycles. Three focus groups were conducted with 19 total residents. Focus groups identified 6 of 11 instrument items with mean quality ratings ≤4.0 on a 1-5 scale. The composite instrument rating of the draft version was 4.1 ± 0.5. After refining the instrument, cognitive interviews with the final version were completed with 22 residents. All items in the final version had quality ratings >4.0; the composite instrument rating was 4.8 ± 0.1. Social capital may be an important factor in resident wellness as residents rely upon each other and external social support to withstand fatigue, burnout, and other negative sequelae of rigorous training. This instrument for assessment of social capital in residents may provide an avenue for data collection and potentially, identification of residents at-risk for wellness degradation. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  3. 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.

    Science.gov (United States)

    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.

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

    OpenAIRE

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

    2010-01-01

    Abstract Background The evidence supporting the effectiveness of educational games in graduate medical education is limited. Anecdotal reports suggest their popularity in that setting. The objective of this study was to explore the support for and the different aspects of use of educational games in family medicine and internal medicine residency programs in the United States. Methods We conducted a survey of family medicine and internal medicine residency program directors in the United Stat...

  5. Natural Radionuclides and 137Cs Concentrations in Rice in Jepara Residence and Internal Dose Estimation Intake by the People

    International Nuclear Information System (INIS)

    Leli-Nirwani; Minarni; Buchari

    2001-01-01

    The measurement of natural radionuclides and 137 Cs concentration in rice in Jepara residence and internal dose estimation intake by people have been conducted. The aim of the research is to determine internal dose estimation of natural radionuclides and 137 Cs intake by people in Jepara residence. By knowing the natural radionuclides and 137 Cs concentrations in rice at Jepara residence, the dose coefficient for adult from ICRP No.72 and the annual intake consumption take from the Indonesian food balance published by BPS, the internal dose from natural radionuclides and 137 Cs intake from food can be calculate concentration of 228 Th, 226 Ra and 137 Cs were found in Bayuran, with the average value was (2.00±0.21) x 10 -5 Bq/kg, (0.09±0.25) x 10 -5 Bq/kg, (19.00±0.06) x 10 -5 Bq/kg respectively the highest 40 K concentration was found in Pandansili with the average was about (8.40 ± 0.34) x 10 -5 Bq/kg. The estimation of equivalent doses from intake of 228 Th, 226 Ra, 40 K, and 137 Cs in rice were the highest in Bayuran the value the average values, respectively, was 0.0039 x 10 -5 μ Sv/yr, 18.09 X 10 -5 μ Sv/yr, 1.63 x 10 -5 μ Sv/yr, 172.38 x 10 -5 μ Sv/yr. Result in this measurement lowest comparing by recommendation IAEA in Safety Series No. 115 in 1996. (author)

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

    Science.gov (United States)

    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/.

  7. Performance of internal medicine residents in the primary interpretation of musculoskeletal radiographs in an ambulatory care setting

    International Nuclear Information System (INIS)

    Mann, F.A.; Stewart, N.R.; Terrell, C.B.

    1990-01-01

    This paper determines the characteristics of misinterpretations of musculoskeletal radiographs by internal medicine residents (IMRs) in an ambulatory care setting. Discordances between IMRs and staff radiologists were prospectively identified and retrospectively reviewed to assess type of error and patient outcome. The setting was an acute ambulatory care clinic at a large university hospital staffed by board-certified emergency medicine faculty and IMRs. Of 541 patients radiographed, 321 (59%) had adequate follow-up to establish outcome. Error characteristics examined included nature and site, type (false negative ([F-] or false positive [F+]), clinical significance, interpreter responsible, and level of interpreter training

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

    Directory of Open Access Journals (Sweden)

    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

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

    Science.gov (United States)

    Mansi, Ishak A

    2011-01-01

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

  10. Minimum Data Set Active Resident Information Report

    Data.gov (United States)

    U.S. Department of Health & Human Services — The MDS Active Resident Report summarizes information for residents currently in nursing homes. The source of these counts is the residents MDS assessment record....

  11. Sleep behaviors and attitudes among internal medicine housestaff in a U.S. university-based residency program.

    Science.gov (United States)

    Rosen, Ilene M; Bellini, Lisa M; Shea, Judy A

    2004-05-01

    Physicians-in-training are susceptible to fatigue given their prolonged duty hours. Sleep deprivation has been shown to alter perceptions of sleepiness and performance. This study examined the state of sleepiness and attitudes about sleep and performance of work- and non-work-related tasks among incoming and current housestaff; and how rotation, call cycle, and call status are related to acute and chronic sleep deprivation and perceptions of sleepiness. A survey instrument was administered in June 2001 to 53 incoming interns and 79 current housestaff at the University Pennsylvania School of Medicine, a university-based internal medicine residency program. All 132 participants (100%) completed the instrument. Acute sleep deprivation was experienced by 34% of the current housestaff and 64% of current housestaff were chronically sleep deprived. Current housestaff admitted to the possibility of dozing while performing various work-related tasks such as writing notes in charts (69%), reviewing medication lists (61%), interpreting labs (51%), and writing orders (46%). At least half of all respondents felt their patients received good care despite residents' sleepiness and as many believed sleep deprivation was a necessary part of training. Nearly half (48%) of current housestaff rotating on a ward service reported acute sleep deprivation, as did 81% of those who were postcall. Over two-thirds of the housestaff on wards and in the ICU reported chronic sleep deprivation. Subjective sleepiness did not vary much across rotations, call cycle, and call status. Chronic and acute sleep deprivation contribute to residents' fatigue. Education could be targeted at attitudes. Further investigation of factors contributing to chronic sleep deprivation in this population is warranted.

  12. Selection criteria of residents for residency programs in Kuwait.

    Science.gov (United States)

    Marwan, Yousef; Ayed, Adel

    2013-01-19

    In Kuwait, 21 residency training programs were offered in the year 2011; however, no data is available regarding the criteria of selecting residents for these programs. This study aims to provide information about the importance of these criteria. A self-administered questionnaire was used to collect data from members (e.g. chairmen, directors, assistants …etc.) of residency programs in Kuwait. A total of 108 members were invited to participate. They were asked to rate the importance level (scale from 1 to 5) of criteria that may affect the acceptance of an applicant to their residency programs. Average scores were calculated for each criterion. Of the 108 members invited to participate, only 12 (11.1%) declined to participate. Interview performance was ranked as the most important criteria for selecting residents (average score: 4.63/5.00), followed by grade point average (average score: 3.78/5.00) and honors during medical school (average score: 3.67/5.00). On the other hand, receiving disciplinary action during medical school and failure in a required clerkship were considered as the most concerning among other criteria used to reject applicants (average scores: 3.83/5.00 and 3.54/5.00 respectively). Minor differences regarding the importance level of each criterion were noted across different programs. This study provided general information about the criteria that are used to accept/reject applicants to residency programs in Kuwait. Future studies should be conducted to investigate each criterion individually, and to assess if these criteria are related to residents' success during their training.

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

    Science.gov (United States)

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

    2009-09-01

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

  14. Emergency Medicine Resident Perceptions of Medical Professionalism.

    Science.gov (United States)

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

    2016-05-01

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

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

    Directory of Open Access Journals (Sweden)

    Shweiki E

    2015-04-01

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

  16. Fifth-year internal medicine residents in Spain: A survey on education, assessment of competencies and job perspectives.

    Science.gov (United States)

    Macía-Rodríguez, C; López Reboiro, M L; Martín Iglesias, D; González-Munera, A; Moreno Diaz, J; Montaño Martínez, A; Ortiz Llauradó, G; Demelo-Rodríguez, P; Muñoz Muñoz, C; Salgado Ordoñez, F

    2018-06-14

    Specialist training is based on the gradual acquisition of expertise, skills and responsibilities. The aim of this study is to determine the opinion of residents regarding their training. This was a cross-sectional descriptive study based on an online survey of 5th-year residents during February and March 2017. A total of 194 residents (62.8% of the total) responded to the survey, 62.9% of whom were women and 50% of whom were younger than 30years, representing hospitals from all levels and from the 17 autonomous communities. More than 80% of the residents choose the specialty once again and believed that the duration of the residence was appropriate; however, 76.3% would eliminate some of their rotations. Most of the residents did not know the objectives of each rotation, and 37.1% felt they were not adequately supervised. Some 82.5% would change the evaluation system, and 68.0% would favour performing an excellence test. Most of the residents had published at least one article or performed one presentation at a congress; however, only 27.8% had completed a doctoral thesis. Although 74.7% of the internists believed they would find employment, only 28.4% had an offer 1month after completing their residence. The residents are satisfied with their training, although there is still a deficit in supervision and dissatisfaction with the method of assessing their knowledge and the precarious job market during the first year for specialists. Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  17. Results of study of Sr-90 and Cs-137 content in organism and effective doses of internal and external irradiation of Ukrainian population residing in different regions

    International Nuclear Information System (INIS)

    Kalmykov, L.; Gur, E.

    1996-01-01

    The authors have studied effective doses of internal and external radiation for 1992-1994 in the residents of Chernigov and Kharkov Regions of Ukraine, i.e. those who live in the zone of strict radioecologic control and in relatively ''clean'' zones, respectively. In 95% of the investigated residents of Chernigov Region Cs-137 activity in the organism was lower than 1500 Bq, maximum amount being 11 kBq. Conditioned Cs-137 effective dose of internal radiation did not exceed 250 micro Sv per year, in 96% of the investigated subjects it was less than 30 micro Sv per year. Mean amount of this radionuclide in the organisms of both adults and children aged 3-6 years residing in Kharkov Region was 90 and 6 Bq respectively, dose being 2 and 0.4 micro Sv per year. Sr-90 amount in the bone tissue decreases with the age and for the residents of Chernigov region it was 7-23 Bq/kg of bone, for the adult residents of Kharkov region it was about 3 Bq/kg of bone. Mean effective dose of internal radiation due to Sr-90 incorporation for the residents of both Kharkov and Chernigov Regions was 0.7 and 1.9 micro Sv per year. Effective dose of external radiation for the residents of Kharkov Region has not changed since the Chernobyl accident. Total effective dose of external and internal radiation in various professional groups for the residents of Chernigov region increased by 80 micro Sv per year which makes up 14% of mean population dose in Ukraine. (author). 11 refs, 5 tabs

  18. Use and utility of Web-based residency program information: a survey of residency applicants.

    Science.gov (United States)

    Embi, Peter J; Desai, Sima; Cooney, Thomas G

    2003-01-01

    The Internet has become essential to the residency application process. In recent years, applicants and residency programs have used the Internet-based tools of the National Residency Matching Program (NRMP, the Match) and the Electronic Residency Application Service (ERAS) to process and manage application and Match information. In addition, many residency programs have moved their recruitment information from printed brochures to Web sites. Despite this change, little is known about how applicants use residency program Web sites and what constitutes optimal residency Web site content, information that is critical to developing and maintaining such sites. To study the use and perceived utility of Web-based residency program information by surveying applicants to an internal medicine program. Our sample population was the applicants to the Oregon Health & Science University Internal Medicine Residency Program who were invited for an interview. We solicited participation using the group e-mail feature available through the Electronic Residency Application Service Post-Office application. To minimize the possibility for biased responses, the study was confined to the period between submission of National Residency Matching Program rank-order lists and release of Match results. Applicants could respond using an anonymous Web-based form or by reply to the e-mail solicitation. We tabulated responses, calculated percentages for each, and performed a qualitative analysis of comments. Of the 431 potential participants, 218 responded (51%) during the study period. Ninety-nine percent reported comfort browsing the Web; 52% accessed the Web primarily from home. Sixty-nine percent learned about residency Web sites primarily from residency-specific directories while 19% relied on general directories. Eighty percent found these sites helpful when deciding where to apply, 69% when deciding where to interview, and 36% when deciding how to rank order programs for the Match. Forty

  19. The Internment and Repatriation of the Japanese-French Nationals Resident in New Caledonia, 1941–1946

    Directory of Open Access Journals (Sweden)

    Rowena Ward

    2017-10-01

    Full Text Available The pre-1941 Japanese population of New Caledonia was decimated by the French administration’s decision to transfer most of the Japanese residents to Australia for internment at the outbreak of the Asia-Pacific theatre of the Second World War. Among the men transferred to Australia were ten men who had been formerly French nationals but had lost their French nationality by decree. The French Administration’s ability to denationalise and intern and then subsequently repatriate the former-Japanese French-nationals was possible due to changes to the French nationality laws and regulations introduced by the Vichy regime. This paper considers the case of the Japanese who had taken French nationality and were denationalised in the context of the changes to the French nationality laws that, in turn, negatively affected the post-1945 sustainability of the Japanese community in New Caledonia.

  20. 26 CFR 301.7701(b)-1 - Resident alien.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 18 2010-04-01 2010-04-01 false Resident alien. 301.7701(b)-1 Section 301.7701... ADMINISTRATION PROCEDURE AND ADMINISTRATION Definitions § 301.7701(b)-1 Resident alien. (a) Scope. Section 301.7701(b)-1(b) provides rules for determining whether an alien individual is a lawful permanent resident...

  1. 26 CFR 1.871-3 - Residence of alien seamen.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 9 2010-04-01 2010-04-01 false Residence of alien seamen. 1.871-3 Section 1.871... (CONTINUED) INCOME TAXES Nonresident Aliens and Foreign Corporations § 1.871-3 Residence of alien seamen. In order to determine whether an alien seaman is a resident of the United States for purposes of the income...

  2. Evaluating Dermatology Residency Program Websites.

    Science.gov (United States)

    Ashack, Kurt A; Burton, Kyle A; Soh, Jonathan M; Lanoue, Julien; Boyd, Anne H; Milford, Emily E; Dunnick, Cory; Dellavalle, Robert P

    2016-03-16

    Internet resources play an important role in how medical students access information related to residency programs.Evaluating program websites is necessary in order to provide accurate information for applicants and provide information regarding areas of website improvement for programs. To date, dermatology residency websites (D  WS) have not been evaluated.This paper evaluates dermatology residency websites based on availability of predefined measures. Using the FREIDA (Fellowship and Residency Electronic Interactive Database) Online database, authors searched forall accredited dermatology program websites. Eligible programs were identified through the FREIDA Online database and had a functioning website. Two authors independently extracted data with consensus or third researcher resolution of differences. This data was accessed and archived from July 15th to July 17th, 2015.Primary outcomes measured were presence of content on education, resident and faculty information, program environment, applicant recruitment, schedule, salary, and website quality evaluated using an online tool (WooRank.com). Out of 117 accredited dermatology residencies, 115 had functioning webpages. Of these, 76.5% (75) had direct links found on the FRIEDA Online database. Most programs contained information on education, faculty, program environment, and applicant recruitment. However, website quality and marketing effectiveness were highly variable; most programs were deemed to need improvements in the functioning of their webpages. Also, additional information on current residents and about potential away rotations were lacking from most websites with only 52.2% (60) and 41.7% (48) of programs providing this content, respectively. A majority of dermatology residency websites contained adequate information on many of the factors we evaluated. However, many were lacking in areas that matter to applicants. We hope this report will encourage dermatology residencyprograms

  3. 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

  4. Ambulatory Care Skills: Do Residents Feel Prepared?

    Directory of Open Access Journals (Sweden)

    Denise Bonds

    2002-10-01

    Full Text Available Objective: To determine resident comfort and skill in performing ambulatory care skills. Methods: Descriptive survey of common ambulatory care skills administered to internal medicine faculty and residents at one academic medical center. Respondents were asked to rate their ability to perform 12 physical exam skills and 6 procedures, and their comfort in performing 7 types of counseling, and obtaining 6 types of patient history (4 point Likert scale for each. Self-rated ability or comfort was compared by gender, status (year of residency, faculty, and future predicted frequency of use of the skill. Results: Residents reported high ability levels for physical exam skills common to both the ambulatory and hospital setting. Fewer felt able to perform musculoskeletal, neurologic or eye exams easily alone. Procedures generally received low ability ratings. Similarly, residents’ comfort in performing common outpatient counseling was also low. More residents reported feeling very comfortable in obtaining history from patients. We found little variation by gender, year of training, or predicted frequency of use. Conclusion: Self-reported ability and comfort for many common ambulatory care skills is low. Further evaluation of this finding in other training programs is warranted.

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

    Science.gov (United States)

    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.

  6. Travel-associated disease among US residents visiting US GeoSentinel clinics after return from international travel.

    Science.gov (United States)

    Hagmann, Stefan H F; Han, Pauline V; Stauffer, William M; Miller, Andy O; Connor, Bradley A; Hale, DeVon C; Coyle, Christina M; Cahill, John D; Marano, Cinzia; Esposito, Douglas H; Kozarsky, Phyllis E

    2014-12-01

    US residents make 60 million international trips annually. Family practice providers need to be aware of travel-associated diseases affecting this growing mobile population. To describe demographics, travel characteristics and clinical diagnoses of US residents who present ill after international travel. Descriptive analysis of travel-associated morbidity and mortality among US travellers seeking care at 1 of the 22 US practices and clinics participating in the GeoSentinel Global Surveillance Network from January 2000 to December 2012. Of the 9624 ill US travellers included in the analysis, 3656 (38%) were tourist travellers, 2379 (25%) missionary/volunteer/research/aid workers (MVRA), 1580 (16%) travellers visiting friends and relatives (VFRs), 1394 (15%) business travellers and 593 (6%) student travellers. Median (interquartile range) travel duration was 20 days (10-60 days). Pre-travel advice was sought by 45%. Hospitalization was required by 7%. Compared with other groups of travellers, ill MVRA travellers returned from longer trips (median duration 61 days), while VFR travellers disproportionately required higher rates of inpatient care (24%) and less frequently had received pre-travel medical advice (20%). Illnesses of the gastrointestinal tract were the most common (58%), followed by systemic febrile illnesses (18%) and dermatologic disorders (17%). Three deaths were reported. Diagnoses varied according to the purpose of travel and region of exposure. Returning ill US international travellers present with a broad spectrum of travel-associated diseases. Destination and reason for travel may help primary health care providers to generate an accurate differential diagnosis for the most common disorders and for those that may be life-threatening. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Simulation Activity in Otolaryngology Residencies.

    Science.gov (United States)

    Deutsch, Ellen S; Wiet, Gregory J; Seidman, Michael; Hussey, Heather M; Malekzadeh, Sonya; Fried, Marvin P

    2015-08-01

    Simulation has become a valuable tool in medical education, and several specialties accept or require simulation as a resource for resident training or assessment as well as for board certification or maintenance of certification. This study investigates current simulation resources and activities in US otolaryngology residency programs and examines interest in advancing simulation training and assessment within the specialty. Web-based survey. US otolaryngology residency training programs. An electronic web-based survey was disseminated to all US otolaryngology program directors to determine their respective institutional and departmental simulation resources, existing simulation activities, and interest in further simulation initiatives. Descriptive results are reported. Responses were received from 43 of 104 (43%) residency programs. Simulation capabilities and resources are available in most respondents' institutions (78.6% report onsite resources; 73.8% report availability of models, manikins, and devices). Most respondents (61%) report limited simulation activity within otolaryngology. Areas of simulation are broad, addressing technical and nontechnical skills related to clinical training (94%). Simulation is infrequently used for research, credentialing, or systems improvement. The majority of respondents (83.8%) expressed interest in participating in multicenter trials of simulation initiatives. Most respondents from otolaryngology residency programs have incorporated some simulation into their curriculum. Interest among program directors to participate in future multicenter trials appears high. Future research efforts in this area should aim to determine optimal simulators and simulation activities for training and assessment as well as how to best incorporate simulation into otolaryngology residency training programs. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

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

    African Journals Online (AJOL)

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

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

    Science.gov (United States)

    Fish, D G

    1966-04-09

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

  10. An Analysis of Publication Productivity During Residency for 1506 Neurosurgical Residents and 117 Residency Departments in North America.

    Science.gov (United States)

    Khan, Nickalus R; Saad, Hassan; Oravec, Chesney S; Norrdahl, Sebastian P; Fraser, Brittany; Wallace, David; Lillard, Jock C; Motiwala, Mustafa; Nguyen, Vincent N; Lee, Siang Liao; Jones, Anna V; Ajmera, Sonia; Kalakoti, Piyush; Dave, Pooja; Moore, Kenneth A; Akinduro, Olutomi; Nyenwe, Emmanuel; Vaughn, Brandy; Michael, L Madison; Klimo, Paul

    2018-05-30

    Bibliometrics is defined as the study of statistical and mathematical methods used to quantitatively analyze scientific literature. The application of bibliometrics in neurosurgery continues to evolve. To calculate a number of publication productivity measures for almost all neurosurgical residents and departments within North America. These measures were correlated with survey results on the educational environment within residency programs. During May to June 2017, data were collected from departmental websites and Scopus to compose a bibliometric database of neurosurgical residents and residency programs. Data related to authorship value and study content were collected on all articles published by residents. A survey of residency program research and educational environment was administered to program directors and coordinators; results were compared with resident academic productivity. The median number of publications in residency was 3; median h-index and Resident index were 1 and 0.17 during residency, respectively. There was a statistically significant difference in academic productivity among male neurosurgical residents compared with females. The majority of articles published were tier 1 clinical articles. Residency program research support was significantly associated with increased resident productivity (P productivity. This study represents the most comprehensive bibliometric assessment of neurosurgical resident academic productivity during training to date. New benchmarks for individual and department academic productivity are provided. A supportive research environment for neurosurgical residents is associated with increased academic productivity, but a scholarly activity requirement was, surprisingly, not shown to have a positive effect.

  11. Conversations with Holocaust survivor residents.

    Science.gov (United States)

    Hirst, Sandra P; LeNavenec, Carole Lynne; Aldiabat, Khaldoun

    2011-03-01

    Traumatic events in one's younger years can have an impact on how an individual copes with later life. One traumatic experience for Jewish individuals was the Holocaust. Some of these people are moving into long-term care facilities. It was within this context that the research question emerged: What are Holocaust survivor residents' perceptions of a life lived as they move into a long-term care facility? For this qualitative study, Holocaust survivors were individually interviewed. Findings emphasize that nursing care needs to ensure that Holocaust survivor residents participate in activities, receive timely health care, and receive recognition of their life experiences. Copyright 2011, SLACK Incorporated.

  12. Evaluation of the Relationship between Current Internal 137Cs Exposure in Residents and Soil Contamination West of Chernobyl in Northern Ukraine.

    Science.gov (United States)

    Kimura, Yuko; Okubo, Yuka; Hayashida, Naomi; Takahashi, Jumpei; Gutevich, Alexander; Chorniy, Sergiy; Kudo, Takashi; Takamura, Noboru

    2015-01-01

    After the Chernobyl Nuclear Power Plant accident, the residents living around the Chernobyl were revealed to have been internally exposed to 137Cs through the intake of contaminated local foods. To evaluate the current situation of internal 137Cs exposure and the relationship between the 137Cs soil contamination and internal exposure in residents, we investigated the 137Cs body burden in residents who were living in 10 selected cities from the northern part of the Zhitomir region, Ukraine, and collected soil samples from three family farms and wild forests of each city to measured 137Cs concentrations. The total number of study participants was 36,862, of which 68.9% of them were female. After 2010, the annual effective doses were less than 0.1 mSv in over 90% of the residents. The 137Cs body burden was significantly higher in autumn than other seasons (p Chernobyl accident, the internal exposure doses to residents living in contaminated areas of northern Ukraine is limited but still related to 137Cs soil contamination. Furthermore, the consumption of local foods is considered to be the cause of internal exposure.

  13. Work-hour restrictions as an ethical dilemma for residents.

    Science.gov (United States)

    Carpenter, Robert O; Austin, Mary T; Tarpley, John L; Griffin, Marie R; Lomis, Kimberly D

    2006-04-01

    We propose that the standardized work-hour limitations have created an ethical dilemma for residents. A survey tool was designed to assess factors that influence the number of hours residents work and report. The program directors of pediatrics, internal medicine, and general surgery at our institution supported their residents' participation. A voluntary, anonymous survey of these residents was performed. One hundred seventy of 265 eligible residents were surveyed. Eighty-one percent of residents surveyed responded. Eighty percent of respondents reported exceeding work-hour restrictions at least once within the past 6 months. The factor of greatest influence measured was concern for patient care (80%). Forty-nine percent of respondents admitted underreporting their work hours. The Accreditation Council for Graduate Medical Education work-hour restrictions have created an ethical dilemma for residents. Our data show that a significant number of residents feel compelled to exceed work-hour regulations and report those hours falsely.

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

    Science.gov (United States)

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

    2015-01-01

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

  15. 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.

    Directory of Open Access Journals (Sweden)

    Masaharu Tsubokura

    Full Text Available Maintaining low levels of chronic internal contamination among residents in radiation-contaminated areas after a nuclear disaster is a great public health concern. However, the efficacy of reduction measures for individual internal contamination remains unknown. To reduce high levels of internal radiation exposure in a group of individuals exposed through environmental sources, we performed careful dietary intervention with identification of suspected contaminated foods, as part of mass voluntary radiation contamination screenings and counseling program in Minamisoma Municipal General Hospital and Hirata Central Hospital. From a total of 30,622 study participants, only 9 residents displayed internal cesium-137 (Cs-137 levels of more than 50 Bq/kg. The median level of internal Cs-137 contamination in these residents at the initial screening was 4,830 Bq/body (range: 2,130-15,918 Bq/body and 69.6 Bq/kg (range: 50.7-216.3 Bq/kg. All these residents with high levels of internal contamination consumed homegrown produce without radiation inspection, and often collected mushrooms in the wild or cultivated them on bed-logs in their homes. They were advised to consume distributed food mainly and to refrain from consuming potentially contaminated foods without radiation inspection and local produces under shipment restrictions such as mushrooms, mountain vegetables, and meat of wild life. A few months after the intervention, re-examination of Cs levels revealed remarkable reduction of internal contamination in all residents. Although the levels of internal radiation exposure appear to be minimal amongst most residents in Fukushima, a subset of the population, who unknowingly consumed highly contaminated foodstuffs, experienced high levels of internal contamination. There seem to be similarities in dietary preferences amongst residents with high internal contamination levels, and intervention based on pre- and post-test counseling and dietary advice from

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

    Science.gov (United States)

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

    2010-03-25

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

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

    Directory of Open Access Journals (Sweden)

    Wilson Mark C

    2010-03-01

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

  18. From Residency to Lifelong Learning.

    Science.gov (United States)

    Brandt, Keith

    2015-11-01

    The residency training experience is the perfect environment for learning. The university/institution patient population provides a never-ending supply of patients with unique management challenges. Resources abound that allow the discovery of knowledge about similar situations. Senior teachers provide counseling and help direct appropriate care. Periodic testing and evaluations identify deficiencies, which can be corrected with future study. What happens, however, when the resident graduates? Do they possess all the knowledge they'll need for the rest of their career? Will medical discovery stand still limiting the need for future study? If initial certification establishes that the physician has the skills and knowledge to function as an independent physician and surgeon, how do we assure the public that plastic surgeons will practice lifelong learning and remain safe throughout their career? Enter Maintenance of Certification (MOC). In an ideal world, MOC would provide many of the same tools as residency training: identification of gaps in knowledge, resources to correct those deficiencies, overall assessment of knowledge, feedback about communication skills and professionalism, and methods to evaluate and improve one's practice. This article discusses the need; for education and self-assessment that extends beyond residency training and a commitment to lifelong learning. The American Board of Plastic Surgery MOC program is described to demonstrate how it helps the diplomate reach the goal of continuous practice improvement.

  19. Machiavelli and the Chief Resident.

    Science.gov (United States)

    Raviglione, Mario C.

    1990-01-01

    Precepts from Machiavelli's "The Prince" are used in giving advice to chief residents on how to balance their responsibilities in working for the welfare of both the housestaff and the institution. Subject discussions include the difficulties of introducing change, setting good examples, and supervising former colleagues and peers. (GLR)

  20. Inpatient Hematology-Oncology Rotation Is Associated With a Decreased Interest in Pursuing an Oncology Career Among Internal Medicine Residents.

    Science.gov (United States)

    McFarland, Daniel C; Holland, Jimmie; Holcombe, Randall F

    2015-07-01

    The demand for hematologists and oncologists is not being met. We hypothesized that an inpatient hematology-oncology ward rotation would increase residents' interest. Potential reasons mitigating interest were explored and included differences in physician distress, empathy, resilience, and patient death experiences. Agreement with the statement "I am interested in pursuing a career/fellowship in hematology and oncology" was rated by residents before and after a hematology-oncology rotation, with 0 = not true at all, 1 = rarely true, 2 = sometimes true, 3 = often true, and 4 = true nearly all the time. House staff rotating on a hematology-oncology service from November 2013 to October 2014 also received questionnaires before and after their rotations containing the Connors-Davidson Resilience Scale, the Impact of Events Scale-Revised, the Interpersonal Reactivity Index, demographic information, and number of dying patients cared for and if a sense of meaning was derived from that experience. Fifty-six residents completed both before- and after-rotation questionnaires (response rate, 58%). The mean interest score was 1.43 initially and decreased to 1.24 after the rotation (P = .301). Female residents' mean score was 1.13 initially and dropped to 0.81 after the rotation (P = .04). Male residents' mean score was 1.71 initially and 1.81 after the rotation (P = .65). Decreased hematology-oncology interest correlated with decreased empathy; male interest decrease correlated with decreased resilience. An inpatient hematology-oncology ward rotation does not lead to increased interest and, for some residents, may lead to decreased interest in the field. Encouraging outpatient hematology-oncology rotations and the cultivation of resilience, empathy, and meaning regarding death experiences may increase resident interest. Copyright © 2015 by American Society of Clinical Oncology.

  1. 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

  2. Evaluation of otolaryngology residency program websites.

    Science.gov (United States)

    Svider, Peter F; Gupta, Amar; Johnson, Andrew P; Zuliani, Giancarlo; Shkoukani, Mahdi A; Eloy, Jean Anderson; Folbe, Adam J

    2014-10-01

    Prior to applying or interviewing, most prospective applicants turn to the Internet when evaluating residency programs, making maintenance of a comprehensive website critical. While certain "intangibles" such as reputation may not be communicated effectively online, residency websites are invaluable for conveying other aspects of a program. Prior analyses have reported that certain criteria such as research experience and didactics are important considerations for applicants. To evaluate the comprehensiveness of otolaryngology residency websites. Review of otolaryngology residency program websites. Websites of 99 civilian residency programs were searched for the presence of 23 criteria. Presence of 23 criteria for application process, incentives, instruction, research, clinical training, and other. Only 5 programs contained at least three-quarters of the criteria analyzed; on average programs reported less than 50% of information sought. Among the 99 residency program websites, a description of the following criteria was noted: comprehensive faculty listing (88%), didactics (80%), contact e-mail (77%), current residents (74%), description of facilities (70%), intern schedule (70%), research requirements (69%), otolaryngology rotation schedule (64%), other courses (61%), ERAS (Electronic Residency Application Service) link (55%), year-to-year responsibility progression (47%), call schedule (40%), active/past research projects (37%), area information (34%), message from the program director (33%) or chair (23%), selection criteria (30%), salary (directly on site) (23%), surgical statistics (18%), parking (9%), and meal allowance (7%). The mean (SD) percentage present of factors encompassing "clinical training" was 55% (23%), significantly higher than the mean (SD) percentage of factors covered under the "incentives" category (19% [11%]; P = .01). The proportion of overall criteria present on websites did not differ on organizing programs by region (range, 42

  3. Texting preferences in a Paediatric residency.

    Science.gov (United States)

    Draper, Lauren; Kuklinski, Cadence; Ladley, Amy; Adamson, Greg; Broom, Matthew

    2017-12-01

    Text messaging is ubiquitous among residents, but remains an underused educational tool. Though feasibility has been demonstrated, evidence of its ability to improve standardised test scores and provide insight on resident texting preferences is lacking. The authors set out to evaluate: (1) satisfaction with a hybrid question-and-answer (Q&A) texting format; and (2) pre-/post-paediatric in-training exam (ITE) performance. A prospective study with paediatrics and internal medicine-paediatrics residents. Residents were divided into subgroups: adolescent medicine (AM) and developmental medicine (DM). Messages were derived from ITE questions and sent Monday-Friday with a 20 per cent variance in messages specific to the sub-group. Residents completed surveys gauging perceptions of the programme, and pre- and post-programme ITE scores were analysed. Forty-one residents enrolled and 32 (78%) completed a post-programme survey. Of those, 21 (66%) preferred a Q&A format with an immediate text response versus information-only texts. The percentage change in ITE scores between 2013 and 2014 was significant. Comparing subgroups, there was no significant difference between the percentage change in ITE scores. Neither group performed significantly better on either the adolescent or developmental sections of the ITE. Text messaging… remains an underused educational tool CONCLUSIONS: Overall, participants improved their ITE scores, but no improvement was seen in the targeted subgroups on the exam. Although Q&A texts are preferred by residents, further assessment is required to assess the effect on educational outcomes. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

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

    Science.gov (United States)

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

    2016-06-01

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

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

    Science.gov (United States)

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

    2008-07-01

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

  6. Gender, age, and place of residence as moderators of the internalized homophobia-depressive symptoms relation among Australian gay men and lesbians.

    Science.gov (United States)

    McLaren, Suzanne

    2015-01-01

    Internalized homophobia is a risk factor for depression among gay men and lesbians. The aim of the study was to test whether the internalized homophobia-depression relation was moderated by gender (stronger among gay men compared with lesbians), age (stronger among younger compared with older gay men and lesbians), and place of residence (stronger among gay men and lesbians who live in rural areas compared with those who live in urban areas). An Australian sample of 311 self-identified gay men and 570 self-identified lesbians, aged 18 to 70 years, completed the Internalized Homophobia Scale and the Centre for Epidemiological Studies Depression Scale. Results indicated that age and gender did not moderate the internalized homophobia-depressive symptoms relation. Place of residence was a significant moderator for gay men but not lesbians. In contrast to the hypothesis, the internalized homophobia-depression relation was significant only among gay men who resided in urban areas. Those who work with gay men should be particularly aware of the significant relationship between internalized homophobia and depressive symptoms among gay men who reside in urban areas.

  7. Resident perceptions of the educational value of night float rotations.

    Science.gov (United States)

    Luks, Andrew M; Smith, C Scott; Robins, Lynne; Wipf, Joyce E

    2010-07-01

    Night float rotations are being increasingly used in the era of resident physician work-hour regulations, but their impact on resident education is not clear. Our objective was to clarify resident perceptions of the educational aspects of night float rotations. An anonymous survey of internal medicine residents at a university-based residency program was completed. Responses were received from 116 of 163 surveyed residents (71%). Residents attended less residents' report (0.10 +/- .43 vs. 2.70 + 0.93 sessions/week, peducational value of night float, sleep cycle adjustment issues, and impact on their personal lives, which correlated with resident evaluations from the regular program evaluation process. In free responses, residents commented that they liked the autonomy and opportunity to improve triage skills on these rotations and confirmed their negative opinions about the sleep-wake cycle and interference with personal lives. Internal medicine residents at a university-based program have negative opinions regarding the educational value of night float rotations. Further work is necessary to determine whether problems exist across programs and specialties.

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

    Science.gov (United States)

    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.

  9. Diversity in Dermatology Residency Programs.

    Science.gov (United States)

    Van Voorhees, Abby S; Enos, Clinton W

    2017-10-01

    Given the change in our population to one that is more racially and ethnically diverse, the topic of diversity in dermatology residency programs has gained attention. In a field that has become highly competitive, diversity is lagging behind. What are the reasons for this? The existing diversity among medical school matriculants is reflective of the applicant pool, and although modest, there has been an increase in applications and acceptances from minority populations. However, these proportions do not carry through to the population applying to dermatology residency. Making sense of this and planning how to recruit a more diverse applicant pool will improve the quality and cultural competency of future dermatologists. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  10. Redesigning journal club in residency.

    Science.gov (United States)

    Al Achkar, Morhaf

    2016-01-01

    The gap between production and implementation of knowledge is the main reason for the suboptimal quality of health care. To eliminate this gap and improve the quality of patient care, journal club (JC) in graduate medical education provides an opportunity for learning the skills of evidence-based medicine. JC, however, continues to face many challenges mainly due to poorly defined goals, inadequate preparation, and lack of interest. This article presents an innovative model to prepare and present JC based on three pillars: dialogical learning through group discussion, mentored residents as peer teachers, and including JC as part of a structured curriculum to learn evidence-based medicine. This engaging model has the potential to transform JC from a moribund session that is daunting for residents into a lively discussion to redefine clinical practice using the most current evidence.

  11. Lake fish as the main contributor of internal dose to lakeshore residents in the Chernobyl contaminated area

    International Nuclear Information System (INIS)

    Travnikova, I.G.; Bazjukin, A.N.; Bruk, G.Ja.; Shutov, V.N.; Balonov, M.I.; Skuterud, L.; Mehli, H.; Strand, P.

    2004-01-01

    Two field expeditions in 1996 studied 137 Cs intake patterns and its content in the bodies of adult residents from the village Kozhany in the Bryansk region, Russia, located on the shore of a drainless peat lake in an area subjected to significant radioactive contamination after the 1986 Chernobyl accident. The 137 Cs contents in lake water and fish were two orders of magnitude greater than in local rivers and flow-through lakes, 10 years after Chernobyl radioactive contamination, and remain stable. The 137 Cs content in lake fish and a mixture of forest mushrooms was between approximately 10-20 kBq/kg, which exceeded the temporary Russian permissible levels for these products by a factor of 20-40. Consumption of lake fish gave the main contribution to internal doses (40-50%) for Kozhany village inhabitants Simple countermeasures, such as Prussian blue doses for dairy cows and pre-boiling mushrooms and fish before cooking, halved the 137 Cs internal dose to inhabitants, even 10 years after the radioactive fallout

  12. Emergency Medicine Resident Perceptions of Medical Professionalism

    Directory of Open Access Journals (Sweden)

    Joshua Jauregui

    2016-05-01

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

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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

  15. Assessment of pediatric residents burnout in a tertiary academic centre

    Directory of Open Access Journals (Sweden)

    Roaa S. Jamjoom

    2018-03-01

    Full Text Available Objectives: To study burnout among pediatric residents at King Abdulazaiz University Hospital in Jeddah, Saudi Arabia. Methods: This is a cross-sectional survey that was administered to all pediatric residents enrolled in the Saudi Paediatric Board program (PGY1-PGY4 in a large tertiary academic hospital in the Western region of Saudi Arabia (King Abdulaziz University Hospital. The survey were sent via E-mail to 50 registered general pediatric residents. Results: Seventy percent of the pediatric residents completed the survey. More than 70% of residents experiencing severe burnout. Forty-three percent suffering emotional exhaustion, 71.8% experiencing depersonalization and 40.6% suffering from low accomplishment. Conclusion: Burnout syndrome appear to be a serious threat to resident well-being in our program. Moreover, pediatric residents in our institute experienced higher levels of depersonalization than their peers nationally and internationally.

  16. Redesigning journal club in residency

    Directory of Open Access Journals (Sweden)

    Al Achkar M

    2016-05-01

    Full Text Available Morhaf Al Achkar Department of Family Medicine, Indiana University, Indianapolis, IN, USA Abstract: The gap between production and implementation of knowledge is the main reason for the suboptimal quality of health care. To eliminate this gap and improve the quality of patient care, journal club (JC in graduate medical education provides an opportunity for learning the skills of evidence-based medicine. JC, however, continues to face many challenges mainly due to poorly defined goals, inadequate preparation, and lack of interest. This article presents an innovative model to prepare and present JC based on three pillars: dialogical learning through group discussion, mentored residents as peer teachers, and including JC as part of a structured curriculum to learn evidence-based medicine. This engaging model has the potential to transform JC from a moribund session that is daunting for residents into a lively discussion to redefine clinical practice using the most current evidence. Keywords: journal club, residents, peer teaching, evidence-based medicine, dialogical learning

  17. Communication from the Resident Representative of the Kingdom of Saudi Arabia to the International Atomic Energy Agency

    International Nuclear Information System (INIS)

    2005-01-01

    The Director General has received a letter dated 10 June 2005 from the Resident Representative of the Kingdom of Saudi Arabia. In the light of the request expressed at the end of the letter, the text of the letter is attached hereto for the information of Member States

  18. Optimal Methods to Screen Men and Women for Intimate Partner Violence: Results from an Internal Medicine Residency Continuity Clinic

    Science.gov (United States)

    Kapur, Nitin A.; Windish, Donna M.

    2011-01-01

    Contradictory data exist regarding optimal methods and instruments for intimate partner violence (IPV) screening in primary care settings. The purpose of this study was to determine the optimal method and screening instrument for IPV among men and women in a primary-care resident clinic. We conducted a cross-sectional study at an urban, academic,…

  19. Communication of 12 April 1996 received from the resident representative of Brazil to the International Atomic Energy Agency

    International Nuclear Information System (INIS)

    1996-01-01

    The document reproduces the text of a note verbale received by the Director general of the IAEA on 12 April 1996 from the Resident Representative of Brazil providing information on the nuclear export policies and practices of the Government of the Federative Republic of Brazil

  20. Communication received from the Resident Representative of the Russian Federation to the IAEA on the establishment, structure and operation of the International Uranium Enrichment Centre

    International Nuclear Information System (INIS)

    2007-01-01

    The Director General has received a communication dated 7 June 2007 from the Resident Representative of the Russian Federation, with an attachment entitled 'Establishment, Structure and Operation of the International Uranium Enrichment Centre'. As requested in that communication, the letter and its attachment are circulated for the information of Member States

  1. Communication dated 16 July 2008 received from the Resident Representative of Japan to the Agency concerning an International Initiative on 3S-Based Nuclear Energy Infrastructure

    International Nuclear Information System (INIS)

    2008-01-01

    The Director General has received a communication dated 16 July 2008 from the Resident Representative of Japan attaching a document entitled 'International Initiative on 3S-based Nuclear Energy Infrastructure'. The communication, and as requested therein, its attachment, are circulated herewith for information

  2. Lawful Permanent Residents Fiscal Year 2014 Country

    Data.gov (United States)

    Department of Homeland Security — Lawful permanent residents (LPRs) are foreign nationals who have been granted the right to reside permanently in the United States. LPRs are also known as 'permanent...

  3. Lawful Permanent Residents Fiscal Year 2011 State

    Data.gov (United States)

    Department of Homeland Security — Lawful permanent residents (LPRs) are foreign nationals who have been granted the right to reside permanently in the United States. LPRs are also known as 'permanent...

  4. Lawful Permanent Residents Fiscal Year 2015 Country

    Data.gov (United States)

    Department of Homeland Security — Lawful permanent residents (LPRs) are foreign nationals who have been granted the right to reside permanently in the United States. LPRs are also known as 'permanent...

  5. Lawful Permanent Residents Fiscal Year 2011 Country

    Data.gov (United States)

    Department of Homeland Security — Lawful permanet residents (LPRs) are foreign nationals who have been gratned the right to reside permanently in the United States. LPRs are also known as 'permanent...

  6. Lawful Permanent Residents Fiscal Year 2016 State

    Data.gov (United States)

    Department of Homeland Security — Lawful permanent residents (LPRs) are foreign nationals who have been granted the right to reside permanently in the United States. LPRs are also known as 'permanent...

  7. Lawful Permanent Residents Fiscal Year 2014 State

    Data.gov (United States)

    Department of Homeland Security — Lawful permanent residents (LPRs) are foreign nationals who have been granted the right to reside permanently in the United States. LPRs are also known as 'permanent...

  8. Lawful Permanent Residents Fiscal Year 2015 State

    Data.gov (United States)

    Department of Homeland Security — Lawful permanent residents (LPRs) are foreign nationals who have been granted the right to reside permanently in the United States. LPRs are also known as 'permanent...

  9. Preparing Dental Students and Residents to Overcome Internal and External Barriers to Evidence-Based Practice.

    Science.gov (United States)

    Coleman, Brandon G; Johnson, Thomas M; Erley, Kenneth J; Topolski, Richard; Rethman, Michael; Lancaster, Douglas D

    2016-10-01

    In recent years, evidence-based dentistry has become the ideal for research, academia, and clinical practice. However, barriers to implementation are many, including the complexity of interpreting conflicting evidence as well as difficulties in accessing it. Furthermore, many proponents of evidence-based care seem to assume that good evidence consistently exists and that clinicians can and will objectively evaluate data so as to apply the best evidence to individual patients' needs. The authors argue that these shortcomings may mislead many clinicians and that students should be adequately prepared to cope with some of the more complex issues surrounding evidence-based practice. Cognitive biases and heuristics shape every aspect of our lives, including our professional behavior. This article reviews literature from medicine, psychology, and behavioral economics to explore the barriers to implementing evidence-based dentistry. Internal factors include biases that affect clinical decision making: hindsight bias, optimism bias, survivor bias, and blind-spot bias. External factors include publication bias, corporate bias, and lack of transparency that may skew the available evidence in the peer-reviewed literature. Raising awareness of how these biases exert subtle influence on decision making and patient care can lead to a more nuanced discussion of addressing and overcoming barriers to evidence-based practice.

  10. TRACER: an ‘eye-opener’ to the patient experience across the transition of care in an internal medicine resident program

    Directory of Open Access Journals (Sweden)

    Lauren B. Meade

    2015-04-01

    Full Text Available Background: A safe patient transition requires a complex set of physician skills within the interprofessional practice. Objective: To evaluate a rotation which applies self-reflection and workplace learning in a TRAnsition of CarE Rotation (TRACER for internal medicine (IM residents. TRACER is a 2-week required IM resident rotation where trainees join a ward team as a quality officer and follow patients into postacute care. Methods: In 2010, residents participated in semistructured, one-on-one interviews as part of ongoing program evaluation. They were asked what they had learned on TRACER, the year prior, and how they used those skills in their practice. Using transcripts, the authors reviewed and coded each transcript to develop themes. Results: Five themes emerged from a qualitative, grounded theory analysis: seeing things from the other side, the ‘ah ha’ moment of fragmented care, team collaboration including understanding nursing scope of practice in different settings, patient understanding, and passing the learning on. TRACER gives residents a moment to breathe and open their eyes to the interprofessional practice setting and the patient's experience of care in transition. Conclusions: Residents learn about transitions of care through self-reflection. This learning is sustained over time and is valued enough to teach to their junior colleagues.

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

    Directory of Open Access Journals (Sweden)

    Rhodes Erinn T

    2010-02-01

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

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

    Directory of Open Access Journals (Sweden)

    Daniel J. Minter

    2018-01-01

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

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

    Science.gov (United States)

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

    2010-02-17

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

  14. Suicidal Thoughts Among Medical Residents with Burnout

    NARCIS (Netherlands)

    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

  15. Pioneering partnerships: Resident involvement from multiple perspectives

    NARCIS (Netherlands)

    Baur, V.E.; Abma, T.A.; Boelsma, F.; Woelders, S.

    2013-01-01

    Resident involvement in residential care homes is a challenge due to shortcomings of consumerist and formal approaches such as resident councils. The PARTNER approach aims to involve residents through collective action to improve their community life and wellbeing. The purpose of this article is to

  16. 45 CFR 233.40 - Residence.

    Science.gov (United States)

    2010-10-01

    .... For purposes of this section: (1) A resident of a State is one: (i) Who is living in the State... resident of the State in which he or she is living other than on a temporary basis. Residence may not depend upon the reason for which the individual entered the State, except insofar as it may bear upon...

  17. 24 CFR 964.140 - Resident training.

    Science.gov (United States)

    2010-04-01

    ... TENANT PARTICIPATION AND TENANT OPPORTUNITIES IN PUBLIC HOUSING Tenant Participation § 964.140 Resident... Resident Management Corporations and duly elected Resident Councils; (3) Public housing policies, programs... colleges, vocational schools; and (4) HUD and other Federal agencies and other local public, private and...

  18. 38 CFR 51.110 - Resident assessment.

    Science.gov (United States)

    2010-07-01

    ...) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.110 Resident assessment. The... physician orders for the resident's immediate care and a medical assessment, including a medical history and...) Review of assessments. The nursing facility management must examine each resident no less than once every...

  19. Sexual Health Education: A Psychiatric Resident's Perspective

    Science.gov (United States)

    Waineo, Eva; Arfken, Cynthia L.; Morreale, Mary K.

    2010-01-01

    Objective: This report discusses psychiatric residents' perceptions of sexual health education and their opinions regarding curricular improvements. Methods: An anonymous, web-based survey was sent to residents in one general psychiatry program (N = 33). The response rate was 69.7%. Results: Residents reported inadequate experience in multiple…

  20. [Prevalence and factors associated with clinical counselling on drug use among internal specialists residents of Andalusia (Spain)].

    Science.gov (United States)

    Juárez-Jiménez, María de la Villa; Pérez-Milena, Alejandro; Valverde-Bolívar, Francisco Javier; Rosa-Garrido, Carmen

    2015-12-01

    To determine the frequency of offering clinical counseling against the consumption of alcohol, tobacco and illegal drugs by internal specialist residents (EIR) of Andalusia, and the factors related to such advice. Multicenter cross-sectional study by self-administered questionnaire sent by mail. EIR of Andalusia. The questionnaire collected the frequency of counseling against the use of alcohol, tobacco and illegal drugs (dependent variable). age/gender, specialty, drug consumption and Fagerström test. Out of a total of 4245 participants, 66% responded, 29% did not respond, and 5% poorly completed questionnaires. The mean age was 29.1(±SD 5.1) years, 69% female, 89% Spanish nationality, 84% in medical training (73% hospital, 27% family medicine). The frequency of counseling against tobacco (85%) and alcohol (82%) is higher than illegal drugs (56%, pformative elements of their own specialty such as personal consumption of alcohol and tobacco, which should be considered for improvement of this preventive activity. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  1. [Motivation and learning strategies in pediatric residents].

    Science.gov (United States)

    Sepúlveda-Vildósola, Ana Carolina; Carrada-Legaria, Sol; Reyes-Lagunes, Isabel

    2015-01-01

    Motivation is an internal mood that moves individuals to act, points them in certain directions, and maintains them in activities, playing a very important role in self-regulated learning and academic performance. Our objective was to evaluate motivation and self-regulation of knowledge in pediatric residents in a third-level hospital, and to determine if there are differences according to the type of specialty and sociodemographic variables. All residents who agreed to participate responded to the Motivated Strategies for Learning Questionnaire. Cronbach alpha was performed to determine reliability. The mean value of each subscale was compared with Student's t test or ANOVA, correlation of subscales with Pearson test. A value of p≤0.05 was considered significant. We included 118 residents. The questionnaire was highly reliable (α=0.939). There were no significant differences in motivation or learning strategies according to sex, marital status, or age. Those residents studying a second or third specialization had significantly higher scores in elaboration, critical thinking, and peer learning. There were significant correlations between intrinsic motivation and self-efficacy with the development of knowledge strategies such as elaboration, critical thinking, and metacognitive self-regulation. Our students present average-to-high scores of motivation and knowledge strategies, with a significant difference according to type of specialization. There is a high correlation between motivation and knowledge strategies.

  2. Psychotherapy Training: Residents' Perceptions and Experiences.

    Science.gov (United States)

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

    2015-10-01

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

  3. How do urology residents manage personal finances?

    Science.gov (United States)

    Teichman, J M; Bernheim, B D; Espinosa, E A; Cecconi, P P; Meyer, J; Pearle, M S; Preminger, G M; Leveillee, R J

    2001-05-01

    To examine personal financial management among residents to answer three research questions: do residents make reasonable financial choices; why do some residents not save; and what steps can be taken to improve residents' personal financial decisions. Portions of the Federal Reserve Board's Survey of Consumer Finances were modified and piloted to elicit demographic, expense, saving, and income data. The final questionnaire was completed by 151 urology residents at 20 programs. Comparing residents with the general population in the same age and income categories, the median debt/household income ratio was 2.38 versus 0.64. Residents had greater educational debt, greater noneducational debt, and lower savings. Resident participation in retirement accounts was 100% at institutions with employer-matching 401k or 403b plans, 63% at institutions with nonmatching 401k or 403b plans, and 48% at institutions without retirement plans for residents (P = 0.002). Fifty-nine percent of residents budgeted expenses, 27% had cash balances below $1000, 51% had paid interest charges on credit cards within the previous year, and 12% maintained unpaid credit card balances greater than $10,000. The median resident income was $38,400. A significant minority of residents appear not to make reasonable financial choices. Some residents save little because of a failure to budget, indebtedness, high projected income growth, or insufficient attention to personal financial management. Residents save more when they are eligible for tax-deferred retirement plans, particularly when their institution matches their contributions. Many residents would benefit from instruction concerning prudent financial management.

  4. Oral and maxillofacial surgery residents have poor understanding of biostatistics.

    Science.gov (United States)

    Best, Al M; Laskin, Daniel M

    2013-01-01

    The purpose of this study was to evaluate residents' understanding of biostatistics and interpretation of research results. A questionnaire previously used in internal medicine residents was modified to include oral and maxillofacial surgery (OMS) examples. The survey included sections to identify demographic and educational characteristics of residents, attitudes and confidence, and the primary outcome-knowledge of biostatistics. In 2009 an invitation to the Internet survey was sent to all 106 program directors in the United States, who were requested to forward it to their residents. One hundred twelve residents responded. The percentage of residents who had taken a course in epidemiology was 53%; biostatistics, 49%; and evidence-based dentistry, 65%. Conversely, 10% of OMS residents had taken none of these classes. Across the 6-item test of knowledge of statistical methods, the mean percentage of correct answers was 38% (SD, 22%). Nearly half of the residents (42%) could not correctly identify continuous, ordinal, or nominal variables. Only 21% correctly identified a case-control study, but 79% correctly identified that the purpose of blinding was to reduce bias. Only 46% correctly interpreted a clinically unimportant and statistically nonsignificant result. None of the demographic or experience factors of OMS residents were related to statistical knowledge. Overall, OMS resident knowledge was below that of internal medicine residents (Pbiostatistics and the interpretation of research and are thus unprepared to interpret the results of published clinical research. Residency programs should include effective biostatistical training in their curricula to prepare residents in evidence-based dentistry. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Perioperative self-reflection among surgical residents.

    Science.gov (United States)

    Peshkepija, Andi N; Basson, Marc D; Davis, Alan T; Ali, Muhammad; Haan, Pam S; Gupta, Rama N; Hardaway, John C; Nebeker, Cody A; McLeod, Michael K; Osmer, Robert L; Anderson, Cheryl I

    2017-09-01

    We studied prevalence and predictors of meaningful self-reflection among surgical residents and with prompting/structured interventions, sought to improve/sustain resident skills. Residents from six programs recorded 1032 narrative self-reflective comments (120 residents), using a web-based platform. If residents identified something learned or to be improved, self-reflection was deemed meaningful. Independent variables PGY level, resident/surgeon gender, study site/Phase1: July2014-August2015 vs. Phase2: September2015-September2016) were analyzed. Meaningful self-reflection was documented in 40.6% (419/1032) of entries. PGY5's meaningfully self-reflected less than PGY1-4's, 26.1% vs. 49.6% (p = 0.002). In multivariate analysis, resident narratives during Phase 2 were 4.7 times more likely to engage in meaningful self-reflection compared to Phase1 entries (p self-reflection, compared to Phase1. Surgical residents uncommonly practice meaningful self-reflection, even when prompted, and PGY5/chief residents reflect less than more junior residents. Substantial/sustained improvements in resident self-reflection can occur with both training and interventions. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. 2003 survey of Canadian radiation oncology residents

    International Nuclear Information System (INIS)

    Yee, Don; Fairchild, Alysa; Keyes, Mira; Butler, Jim; Dundas, George

    2005-01-01

    Purpose: Radiation oncology's popularity as a career in Canada has surged in the past 5 years. Consequently, resident numbers in Canadian radiation oncology residencies are at all-time highs. This study aimed to survey Canadian radiation oncology residents about their opinions of their specialty and training experiences. Methods and Materials: Residents of Canadian radiation oncology residencies that enroll trainees through the Canadian Resident Matching Service were identified from a national database. Residents were mailed an anonymous survey. Results: Eight of 101 (7.9%) potential respondents were foreign funded. Fifty-two of 101 (51.5%) residents responded. A strong record of graduating its residents was the most important factor residents considered when choosing programs. Satisfaction with their program was expressed by 92.3% of respondents, and 94.3% expressed satisfaction with their specialty. Respondents planning to practice in Canada totaled 80.8%, and 76.9% plan to have academic careers. Respondents identified job availability and receiving adequate teaching from preceptors during residency as their most important concerns. Conclusions: Though most respondents are satisfied with their programs and specialty, job availability and adequate teaching are concerns. In the future, limited time and resources and the continued popularity of radiation oncology as a career will magnify the challenge of training competent radiation oncologists in Canada

  7. Current perspectives on chief residents in psychiatry.

    Science.gov (United States)

    Warner, Christopher H; Rachal, James; Breitbach, Jill; Higgins, Michael; Warner, Carolynn; Bobo, William

    2007-01-01

    The authors examine qualitative data from outgoing chief residents in psychiatry from the 2004-2005 academic year to 1) determine common characteristics between programs, 2) examine the residents' perspectives on their experiences, and 3) determine their common leadership qualities. The authors sent out self-report surveys via e-mail to 89 outgoing chief residents who attended the APA/Lilly Chief Resident Executive Leadership Program. Fifty-three (60%) chief residents responded. Although most chief residents are senior residents, over 20% are in their third postgraduate year. Two-thirds of programs have more than one chief resident each year. Most chief residents believe that their "participating" leadership style, existing leadership skills, and interpersonal skills contributed to their overall positive experiences. Successfully performing duties as a chief resident entails functioning in a variety of roles and demands attention to leadership qualities of the individual. Developing existing leadership skills, clarifying expectations, and providing mentorship to chief residents will ensure successful transition into practice, and the advancement of the field of psychiatry.

  8. Acceptability and Impact of a Required Palliative Care Rotation with Prerotation and Postrotation Observed Simulated Clinical Experience during Internal Medicine Residency Training on Primary Palliative Communication Skills.

    Science.gov (United States)

    Vergo, Maxwell T; Sachs, Sharona; MacMartin, Meredith A; Kirkland, Kathryn B; Cullinan, Amelia M; Stephens, Lisa A

    2017-05-01

    Improving communication training for primary palliative care using a required palliative care rotation for internal medicine (IM) residents has not been assessed. To assess skills acquisition and acceptability for IM residents not selecting an elective. A consecutive, single-arm cohort underwent preobjective structured clinical examination (OSCE) with learner-centric feedback, two weeks of clinical experience, and finally a post-OSCE to crystallize learner-centric take home points. IM second year residents from Dartmouth-Hitchcock were exposed to a required experiential palliative care rotation. Pre- and post-OSCE using a standardized score card for behavioral skills, including patient-centered interviewing, discussing goals of care/code status, and responding to emotion, as well as a confidential mixed qualitative and quantitative evaluation of the experience. Twelve residents were included in the educational program (two were excluded because of shortened experiences) and showed statistically significant improvements in overall communication and more specifically in discussing code status and responding to emotions. General patient-centered interviewing skills were not significantly improved, but prerotation scores reflected pre-existing competency in this domain. Residents viewed the observed simulated clinical experience (OSCE) and required rotation as positive experiences, but wished for more opportunities to practice communication skills in real clinical encounters. A required palliative care experiential rotation flanked by OSCEs at our institution improved the acquisition of primary palliative care communication skills similarly to other nonclinical educational platforms, but may better meet the needs of the resident and faculty as well as address all required ACGME milestones.

  9. Neurosurgical Resident Training in Germany.

    Science.gov (United States)

    Stienen, Martin N; Gempt, Jens; Gautschi, Oliver P; Demetriades, Andreas K; Netuka, David; Kuhlen, Dominique E; Schaller, Karl; Ringel, Florian

    2017-07-01

    Introduction  Efficient neurosurgical training is of paramount importance to provide continuing high-quality medical care to patients. In this era of law-enforced working hour restrictions, however, maintaining high-quality training can be a challenge and requires some restructuring. We evaluated the current status of resident training in Germany. Methods  An electronic survey was sent to European neurosurgical trainees between June 2014 and March 2015. The responses of German trainees were compared with those of trainees from other European countries. Logistic regression analysis was performed to assess the effect size of the relationship between a trainee being from Germany and the outcome (e.g., satisfaction, working time). Results  Of 532 responses, 95 were from German trainees (17.8%). In a multivariate analysis corrected for baseline group differences, German trainees were 29% as likely as non-German trainees to be satisfied with clinical lectures given at their teaching facility (odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.18-0.49; p  hours as requested from the European Working Time Directive 2003/88/EC, and in an international comparison, German trainees were twice as likely to work > 50 hours per week (OR: 2.13; 95% CI, 1.25-3.61; p  = 0.005). This working time, however, is less spent in the operating suite (OR: 0.26; 95% CI, 0.11-0.59; p  = 0.001) and more doing administrative work (OR: 1.83; 95% CI, 1.13-2.96; p  = 0.015). Conclusion  Some theoretical and practical aspects of neurosurgical training are superior, but a considerable proportion of relevant aspects are inferior in Germany compared with other European countries. The present analyses provide the opportunity for a critical review of the local conditions in German training facilities. Georg Thieme Verlag KG Stuttgart · New York.

  10. A Professionalism Curricular Model to Promote Transformative Learning Among Residents.

    Science.gov (United States)

    Foshee, Cecile M; Mehdi, Ali; Bierer, S Beth; Traboulsi, Elias I; Isaacson, J Harry; Spencer, Abby; Calabrese, Cassandra; Burkey, Brian B

    2017-06-01

    Using the frameworks of transformational learning and situated learning theory, we developed a technology-enhanced professionalism curricular model to build a learning community aimed at promoting residents' self-reflection and self-awareness. The RAPR model had 4 components: (1) R ecognize : elicit awareness; (2) A ppreciate : question assumptions and take multiple perspectives; (3) P ractice : try new/changed perspectives; and (4) R eflect : articulate implications of transformed views on future actions. The authors explored the acceptability and practicality of the RAPR model in teaching professionalism in a residency setting, including how residents and faculty perceive the model, how well residents carry out the curricular activities, and whether these activities support transformational learning. A convenience sample of 52 postgraduate years 1 through 3 internal medicine residents participated in the 10-hour curriculum over 4 weeks. A constructivist approach guided the thematic analysis of residents' written reflections, which were a required curricular task. A total of 94% (49 of 52) of residents participated in 2 implementation periods (January and March 2015). Findings suggested that RAPR has the potential to foster professionalism transformation in 3 domains: (1) attitudinal, with participants reporting they viewed professionalism in a more positive light and felt more empathetic toward patients; (2) behavioral, with residents indicating their ability to listen to patients increased; and (3) cognitive, with residents indicating the discussions improved their ability to reflect, and this helped them create meaning from experiences. Our findings suggest that RAPR offers an acceptable and practical strategy to teach professionalism to residents.

  11. A theory-informed, process-oriented Resident Scholarship Program.

    Science.gov (United States)

    Thammasitboon, Satid; Darby, John B; Hair, Amy B; Rose, Karen M; Ward, Mark A; Turner, Teri L; Balmer, Dorene F

    2016-01-01

    The Accreditation Council for Graduate Medical Education requires residency programs to provide curricula for residents to engage in scholarly activities but does not specify particular guidelines for instruction. We propose a Resident Scholarship Program that is framed by the self-determination theory (SDT) and emphasize the process of scholarly activity versus a scholarly product. The authors report on their longitudinal Resident Scholarship Program, which aimed to support psychological needs central to SDT: autonomy, competence, and relatedness. By addressing those needs in program aims and program components, the program may foster residents' intrinsic motivation to learn and to engage in scholarly activity. To this end, residents' engagement in scholarly processes, and changes in perceived autonomy, competence, and relatedness were assessed. Residents engaged in a range of scholarly projects and expressed positive regard for the program. Compared to before residency, residents felt more confident in the process of scholarly activity, as determined by changes in increased perceived autonomy, competence, and relatedness. Scholarly products were accomplished in return for a focus on scholarly process. Based on our experience, and in line with the SDT, supporting residents' autonomy, competence, and relatedness through a process-oriented scholarship program may foster the curiosity, inquisitiveness, and internal motivation to learn that drives scholarly activity and ultimately the production of scholarly products.

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

    Science.gov (United States)

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

    2012-08-01

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

  13. Have the 'black clouds' cleared with new residency programme regulations?

    Science.gov (United States)

    Schissler, A J; Einstein, A J

    2016-06-01

    For decades, residents believed to work harder have been referred to as having a 'black cloud'. Residency training programmes recently instituted changes to improve physician wellness and achieve comparable clinical workload. All Internal Medicine residents in the internship class of 2014 at Columbia were surveyed to assess for the ongoing presence of 'black cloud' trainees. While some residents are still thought to have this designation, they did not have a greater workload when compared to their peers. © 2016 Royal Australasian College of Physicians.

  14. The effect of question format and task difficulty on reasoning strategies and diagnostic performance in Internal Medicine residents.

    Science.gov (United States)

    Heemskerk, Laura; Norman, Geoff; Chou, Sophia; Mintz, Marcy; Mandin, Henry; McLaughlin, Kevin

    2008-11-01

    Previous studies have suggested an association between reasoning strategies and diagnostic success, but the influence on this relationship of variables such as question format and task difficulty, has not been studied. Our objective was to study the association between question format, task difficulty, reasoning strategies and diagnostic success. Study participants were 13 Internal Medicine residents at the University of Calgary. Each was given eight problem-solving questions in four clinical presentations and were randomized to groups that differed only in the question format, such that a question presented as short answer (SA) to the first group was presented as extended matching (EM) to the second group. There were equal numbers of SA/EM questions and straightforward/difficult tasks. Participants performed think-aloud during diagnostic reasoning. Data were analyzed using multiple logistic regression. Question format was associated with reasoning strategies; hypothetico-deductive reasoning being used more frequently on EM questions and scheme-inductive reasoning on SA questions. For SA question, non-analytic reasoning alone was used more frequently to answer straightforward cases than difficult cases, whereas for EM questions no such association was observed. EM format and straightforward task increased the odds of diagnostic success, whereas hypothetico-deductive reasoning was associated with reduced odds of success. Question format and task difficulty both influence diagnostic reasoning strategies and studies that examine the effect of reasoning strategies on diagnostic success should control for these effects. Further studies are needed to investigate the effect of reasoning strategies on performance of different groups of learners.

  15. Population attributable risk for chlamydia infection in a cohort of young international travellers (backpackers) and residents in Australia.

    Science.gov (United States)

    Wand, Handan; Guy, Rebecca; Donovan, Basil; McNulty, Anna

    2011-02-23

    To estimate the population attributable risk (PAR) for Chlamydia trachomatis infection in young men and women in Sydney, Australia. Multivariate logistic regression was used to examine the association between demographic, sexual behaviour and other potential risk factors and chlamydia positivity in young (≤ 30 years) heterosexual international travellers (backpackers) and Australian residents attending a sexual health clinic. Point and interval estimates of PAR were calculated to quantify the proportion of chlamydia infections that can theoretically be prevented if a combination of risk factors is eliminated from a target population. In males, the PAR associated with inconsistent condom use in the past 3 months was 65% (95% CI 56% to 71%) in backpackers compared to 50% (95% CI 41% to 56%) in non-backpackers and the PAR associated with reporting three or more female sexual partners in the past 3 months was similar between male backpackers and non-backpackers (33% (95% CI 28% to 40%) and 36% (95% CI 32% to 41%), respectively). In females, the PAR associated with inconsistent condom use in the past 3 months was 51% (95% CI 42% to 59%) in backpackers compared to 41% (95% CI 31% to 51%) in non-backpackers, and the PAR associated with reporting three or more male sexual partners in the past 3 months was 14% (95% CI 11% to 18%) in backpackers compared to 30% (95% CI 25% to 37%) in non-backpackers. These findings suggest that the largest number of chlamydia infections could be avoided by increasing condom use, particularly in backpackers. Reporting multiple partners was also associated with a large proportion of infections and the risk associated with this behaviour should be considered in health promotion strategies.

  16. Population attributable risk for chlamydia infection in a cohort of young international travellers (backpackers) and residents in Australia

    Science.gov (United States)

    Guy, Rebecca; Donovan, Basil; McNulty, Anna

    2011-01-01

    Aim To estimate the population attributable risk (PAR) for Chlamydia trachomatis infection in young men and women in Sydney, Australia. Method Multivariate logistic regression was used to examine the association between demographic, sexual behaviour and other potential risk factors and chlamydia positivity in young (≤30 years) heterosexual international travellers (backpackers) and Australian residents attending a sexual health clinic. Point and interval estimates of PAR were calculated to quantify the proportion of chlamydia infections that can theoretically be prevented if a combination of risk factors is eliminated from a target population. Results In males, the PAR associated with inconsistent condom use in the past 3 months was 65% (95% CI 56% to 71%) in backpackers compared to 50% (95% CI 41% to 56%) in non-backpackers and the PAR associated with reporting three or more female sexual partners in the past 3 months was similar between male backpackers and non-backpackers (33% (95% CI 28% to 40%) and 36% (95% CI 32% to 41%), respectively). In females, the PAR associated with inconsistent condom use in the past 3 months was 51% (95% CI 42% to 59%) in backpackers compared to 41% (95% CI 31% to 51%) in non-backpackers, and the PAR associated with reporting three or more male sexual partners in the past 3 months was 14% (95% CI 11% to 18%) in backpackers compared to 30% (95% CI 25% to 37%) in non-backpackers. Conclusion These findings suggest that the largest number of chlamydia infections could be avoided by increasing condom use, particularly in backpackers. Reporting multiple partners was also associated with a large proportion of infections and the risk associated with this behaviour should be considered in health promotion strategies. PMID:22021720

  17. Survey of Sexual Education among Residents from Different Specialties

    Science.gov (United States)

    Morreale, Mary K.; Arfken, Cynthia L.; Balon, Richard

    2010-01-01

    Objective: This study aims to determine how residents are being educated regarding sexual health, and it assesses attitudes toward sexual education and barriers to evaluating patients' sexuality. Methods: An anonymous Internet survey was sent to 195 residents in family practice, internal medicine, obstetrics and gynecology, and psychiatry at a…

  18. Universal problems during residency: abuse and harassment.

    Science.gov (United States)

    Nagata-Kobayashi, Shizuko; Maeno, Tetsuhiro; Yoshizu, Misaki; Shimbo, Takuro

    2009-07-01

    Perceived abuse or harassment during residency has a negative impact on residents' health and well-being. This issue pertains not only to Western countries, but also to those in Asia. In order to launch strong international preventive measures against this problem, it is necessary to establish the generality and cultural specificity of this problem in different countries. Therefore, we investigated mistreatment among resident doctors in Japan. In 2007, a multi-institutional, cross-sectional survey was conducted at 37 hospitals. A total of 619 residents (409 men, 210 women) were recruited. Prevalence of mistreatment in six categories was evaluated: verbal abuse; physical abuse; academic abuse; sexual harassment; gender discrimination, and alcohol-associated harassment. In addition, alleged abusers, the emotional effects of abusive experiences, and reluctance to report the abuse to superiors were investigated. Male and female responses were statistically compared using chi-square analysis. A total of 355 respondents (228 men, 127 women) returned a completed questionnaire (response rate 57.4%). Mistreatment was reported by 84.8% of respondents (n = 301). Verbal abuse was the most frequently experienced form of mistreatment (n = 256, 72.1%), followed by alcohol-associated harassment (n = 184, 51.8%). Among women, sexual harassment was also often reported (n = 74, 58.3%). Doctors were most often reported as abusers (n = 124, 34.9%), followed by patients (n = 77, 21.7%) and nurses (n = 61, 17.2%). Abuse was reported to have occurred most frequently during surgical rotations (n = 98, 27.6%), followed by rotations in departments of internal medicine (n = 76, 21.4%), emergency medicine (n = 41, 11.5%) and anaesthesia (n = 40, 11.3%). Very few respondents reported their experiences of abuse to superiors (n = 36, 12.0%). The most frequent emotional response to experiences of abuse was anger (n = 84, 41.4%). Mistreatment during residency is a universal phenomenon. Deliberation

  19. A Time Study of Plastic Surgery Residents.

    Science.gov (United States)

    Lau, Frank H; Sinha, Indranil; Jiang, Wei; Lipsitz, Stuart R; Eriksson, Elof

    2016-05-01

    Resident work hours are under scrutiny and have been subject to multiple restrictions. The studies supporting these changes have not included data on surgical residents. We studied the workday of a team of plastic surgery residents to establish prospective time-study data of plastic surgery (PRS) residents at a single tertiary-care academic medical center. Five trained research assistants observed all residents (n = 8) on a PRS service for 10 weeks and produced minute-by-minute activity logs. Data collection began when the team first met in the morning and continued until the resident being followed completed all non-call activities. We analyzed our data from 3 perspectives: 1) time spent in direct patient care (DPC), indirect patient care, and didactic activities; 2) time spent in high education-value activities (HEAs) versus low education-value activities; and 3) resident efficiency. We defined HEAs as activities that surgeons must master; other activities were LEAs. We quantified resident efficiency in terms of time fragmentation and time spent waiting. A total of 642.4 hours of data across 50 workdays were collected. Excluding call, residents worked an average of 64.2 hours per week. Approximately 50.7% of surgical resident time was allotted to DPC, with surgery accounting for the largest segment of this time (34.8%). Time spent on HEAs demonstrated trended upward with higher resident level (P = 0.086). Time in spent in surgery was significantly associated with higher resident levels (P time study of PRS residents, we found that compared with medicine trainees, surgical residents spent 3.23 times more time on DPC. High education-value activities comprised most of our residents' workdays. Surgery was the leading component of both DPC and HEAs. Our residents were highly efficient and fragmented, with the majority of all activities requiring 4 minutes or less. Residents spent a large portion of their time waiting for other services. In light of these data, we

  20. Results of the American Academy of Neurology resident survey.

    Science.gov (United States)

    Freeman, W D; Nolte, C M; Matthews, B R; Coleman, M; Corboy, J R

    2011-03-29

    To assess the effect of neurology residency education as trainees advance into independent practice, the American Academy of Neurology (AAN) elected to survey all graduating neurology residents at time of graduation and in 3-year cycles thereafter. A 22-question survey was sent to all neurology residents completing residency training in the United States in 2007. Of 523 eligible residents, 285 (54.5%) responded. Of these, 92% reported good to excellent quality teaching of basic neurology from their faculty; however, 47% noted less than ideal training in basic neuroscience. Two-thirds indicated that the Residency In-service Training Examination was used only as a self-assessment tool, but reports of misuse were made by some residents. After residency, 78% entered fellowships (with 61% choosing a fellowship based on interactions with a mentor at their institution), whereas 20% entered practice directly. After adjustment for the proportion of residents who worked before the duty hour rules were implemented and after their implementation, more than half reported improvement in quality of life (87%), education (60%), and patient care (62%). The majority of international medical graduates reported wanting to stay in the United States to practice rather than return to their country of residence. Neurology residents are generally satisfied with training, and most entered a fellowship. Duty hour implementation may have improved resident quality of life, but reciprocal concerns were raised about impact on patient care and education. Despite the majority of international trainees wishing to stay in the United States, stricter immigration laws may limit their entry into the future neurology workforce.

  1. Neurocritical care education during neurology residency

    Science.gov (United States)

    Drogan, O.; Manno, E.; Geocadin, R.G.; Ziai, W.

    2012-01-01

    Objective: Limited information is available regarding the current state of neurocritical care education for neurology residents. The goal of our survey was to assess the need and current state of neurocritical care training for neurology residents. Methods: A survey instrument was developed and, with the support of the American Academy of Neurology, distributed to residency program directors of 132 accredited neurology programs in the United States in 2011. Results: A response rate of 74% (98 of 132) was achieved. A dedicated neuroscience intensive care unit (neuro-ICU) existed in 64%. Fifty-six percent of residency programs offer a dedicated rotation in the neuro-ICU, lasting 4 weeks on average. Where available, the neuro-ICU rotation was required in the vast majority (91%) of programs. Neurology residents' exposure to the fundamental principles of neurocritical care was obtained through a variety of mechanisms. Of program directors, 37% indicated that residents would be interested in performing away rotations in a neuro-ICU. From 2005 to 2010, the number of programs sending at least one resident into a neuro-ICU fellowship increased from 14% to 35%. Conclusions: Despite the expansion of neurocritical care, large proportions of US neurology residents have limited exposure to a neuro-ICU and neurointensivists. Formal training in the principles of neurocritical care may be highly variable. The results of this survey suggest a charge to address the variability of resident education and to develop standardized curricula in neurocritical care for neurology residents. PMID:22573636

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

    Science.gov (United States)

    Daniels, Vijay John; Harley, Dwight

    2017-07-01

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

  3. PNEUMONIA IN NURSING HOME RESIDENTS

    Directory of Open Access Journals (Sweden)

    Renato Eržen

    2002-10-01

    Full Text Available Background. Pneumonia remains one of the leading causes of morbidity and mortality worldwide, especially in advanced age. Prognosis of the disease depends on premorbid condition and immune competence of the patient, severity of the disease and causative microorganism. In our analysis we wanted to establish clinical, x-ray and microbiological characteristics of pneumonia in nursing home residents, estimate suitability of therapeutic measures and find out risk factors for adverse outcome in this group of patients.Material and methods. This retrospective study includes all nursing home residents hospitalised due to CAP in Hospital Golnik in 2000. Clinical data was/were evaluated according to case history. Microbiological data and laboratory results were gathered from the patients files. Chi-square test was used for statistical analysis.Results. 30 patients, 17 women were included, aged 82.5 ± 11.7 years. 60% of patients had at least 2 accompanying diseases, most frequently cardiovascular and neurologic diseases. At admittance 83% of patients presented with severe form of the disease. Dispnea (93%, tachypnea, cough (67% and confusion (47% dominate clinical picture. Patients rarely expectorate, are frequently hypoxemic (93%, have leucocytosis (63%, electrolyte disturbances and elevated urea (67%. According to the microbiologic results most frequent causative agents are Enterobacteriae, S. pneumoniae, H. influenzae and also some multiresistant bacteria. Amoxycillin with clavulanic acid was the most frequently used antibiotic, followed by macrolides and 3rd generation cephalosporines.9 patients died, mortality rate was 30%. Their average age was 83,4 years, 67% of them had more than 2 accompanying diseases, all of them severe form of the disease, 89% severe respiratory insufficiency and 22% positive hemoculture.Conclusions. Patients are characterised with numerous comorbidities and advanced age. Clinical presentation is unspecific. Mortality is high

  4. Case-Logging Practices in Otolaryngology Residency Training: National Survey of Residents and Program Directors.

    Science.gov (United States)

    Dermody, Sarah M; Gao, William; McGinn, Johnathan D; Malekzadeh, Sonya

    2017-06-01

    Objective (1) Evaluate the consistency and manner in which otolaryngology residents log surgical cases. (2) Assess the extent of instruction and guidance provided by program directors on case-logging practices. Study Design Cross-sectional national survey. Setting Accreditation Council for Graduate Medical Education otolaryngology residency programs in the United States. Subjects and Methods US otolaryngology residents, postgraduate year 2 through graduating chiefs as of July 2016, were recruited to respond to an anonymous questionnaire designed to characterize surgical case-logging practices. Program directors of US otolaryngology residency programs were recruited to respond to an anonymous questionnaire to elucidate how residents are instructed to log cases. Results A total of 272 residents and 53 program directors completed the survey, yielding response rates of 40.6% and 49.5%, respectively. Perceived accuracy of case logs is low among residents and program directors. Nearly 40% of residents purposely choose not to log certain cases, and 65.1% of residents underreport cases performed. More than 80% of program directors advise residents to log procedures performed outside the operating room, yet only 16% of residents consistently log such cases. Conclusion Variability in surgical case-logging behaviors and differences in provided instruction highlight the need for methods to improve consistency of logging practices. It is imperative to standardize practices across otolaryngology residency programs for case logs to serve as an accurate measure of surgical competency. This study provides a foundation for reform efforts within residency programs and for the Resident Case Log System.

  5. 26 CFR 1.871-5 - Loss of residence by an alien.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 9 2010-04-01 2010-04-01 false Loss of residence by an alien. 1.871-5 Section 1... (CONTINUED) INCOME TAXES Nonresident Aliens and Foreign Corporations § 1.871-5 Loss of residence by an alien. An alien who has acquired residence in the United States retains his status as a resident until he...

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

    Science.gov (United States)

    Serrano, Karen

    2007-08-01

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

  7. Communication of 19 June 1997 received from the resident representative of the United Kingdom of Great Britain and Northern Ireland to the International Atomic Energy Agency

    International Nuclear Information System (INIS)

    1997-07-01

    The document reproduces the text of a letter dated 19 June 1997 received by the Director General of the IAEA from the Resident Representative of the United Kingdom of Great Britain and Northern Ireland, referring to the Revised Supplementary Agreement Concerning the Provision of Technical Assistance by the International Atomic Energy Agency to the Government of the United Kingdom of Great Britain and Northern Ireland on behalf of the Government of Hong Kong done at Vienna on 4 February 1983

  8. 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

  9. Communication of 28 February 1997 received from the resident representative of Brazil to the International Atomic Energy Agency

    International Nuclear Information System (INIS)

    1997-01-01

    The document reproduces the text of the 'Joint Declaration on the Transport of Radioactive Waste' of the Governments of the Republic of Argentina, the Federative Republic of Brazil, the Republic of Chile and the Eastern Republic of Uruguay, issued to the press on 17 January 1997. The document was received by the Director General of the IAEA on 4 March 1997 from the Resident Representative of the Federative Republic of Brazil on behalf of his Government and the Governments of the other three countries involved

  10. Resident duty hours in Canada: a survey and national statement.

    Science.gov (United States)

    Masterson, Mark F; Shrichand, Pankaj; Maniate, Jerry M

    2014-01-01

    Physicians in general, and residents in particular, are adapting to duty schedules in which they have fewer continuous work hours; however, there are no Canadian guidelines on duty hours restrictions. To better inform resident duty hour policy in Canada, we set out to prepare a set of recommendations that would draw upon evidence reported in the literature and reflect the experiences of resident members of the Canadian Association of Internes and Residents (CAIR). A survey was prepared and distributed electronically to all resident members of CAIR. A total of 1796 eligible residents participated in the survey. Of those who responded, 38% (601) reported that they felt they could safely provide care for up to 16 continuous hours, and 20% (315) said that 12 continuous hours was the maximum period during which they could safely provide care (n=1592). Eighty-two percent (1316) reported their perception that the quality of care they had provided suffered because of the number of consecutive hours worked (n=1598). Only 52% (830) had received training in handover (n=1594); those who had received such training reported that it was commonly provided through informal modelling. On the basis of these data and the existing literature, CAIR recommends that resident duty hours be managed in a way that does not endanger the health of residents or patients; does not impair education; is flexible; and does not violate ethical or legal standards. Further, residents should be formally trained in handover skills and alternative duty hour models.

  11. Motherhood during residency training: challenges and strategies.

    Science.gov (United States)

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

    2005-07-01

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

  12. Stress and burnout among Swiss dental residents

    OpenAIRE

    Divaris, Kimon; Lai, Caroline S; Polychronopoulou, Argy; Eliades, Theodore; Katsaros, Christos

    2012-01-01

    Stress and burnout have been well-documented in graduate medical and undergraduate dental education, but studies among dental graduate students and residents are sparse. The purpose of this investigation was to examine perceived stressors and three dimensions of burnout among dental residents enrolled in the University of Bern, Switzerland. Thirty-six residents enrolled in five specialty programmes were administered the Graduate Dental Environment Stress (GDES30) questionnaire and the Maslach...

  13. Making residency work hour rules work.

    Science.gov (United States)

    Cohen, I Glenn; Czeisler, Charles A; Landrigan, Christopher P

    2013-01-01

    In July 2011, the ACGME implemented new rules that limit interns to 16 hours of work in a row, but continue to allow 2nd-year and higher resident physicians to work for up to 28 consecutive hours. Whether the ACGME's 2011 work hour limits went too far or did not go far enough has been hotly debated. In this article, we do not seek to re-open the debate about whether these standards get matters exactly right. Instead, we wish to address the issue of effective enforcement. That is, now that new work hour limits have been established, and given that the ACGME has been unable to enforce work hour limits effectively on its own, what is the best way to make sure the new limits are followed in order to reduce harm to residents, patients, and others due to sleep-deprived residents? We focus on three possible national approaches to the problem, one rooted in funding, one rooted in disclosure, and one rooted in tort law. © 2013 American Society of Law, Medicine & Ethics, Inc.

  14. Radiology residents' experience with intussusception reduction

    International Nuclear Information System (INIS)

    Bateni, Cyrus; Stein-Wexler, Rebecca; Wootton-Gorges, Sandra L.; Li, Chin-Shang

    2011-01-01

    Residents should be exposed to adequate procedural volume to act independently upon completion of training. Informal inquiry led us to question whether residents encounter enough intussusception reductions to become comfortable with the procedure. We sought to determine radiology residents' exposure to intussusception reductions, and whether their experiences vary by region or institution. U.S. radiology residency program directors were asked to encourage their residents to complete a 12-question online survey describing characteristics of their pediatric radiology department, experiences with intussusception reduction, and confidence in their own ability to perform the procedure. Six hundred sixty-four residents responded during the study period. Of those, 308 (46.4%) had not experienced an intussusception reduction, and 228 (34%) had experienced only one or two. Twenty-two percent of fourth-year residents had never experienced an intussusception reduction, and 21% had experienced only one. Among second- through fourth-year residents, only 99 (18.3%) felt confident that they could competently reduce an intussusception (P < 0.0001), and 336 (62.2%) thought they would benefit from a computer-assisted training model simulating intussusception reduction (P < 0.0001). Radiology residents have limited opportunity to learn intussusception reduction and therefore lack confidence. Most think they would benefit from additional training with a computer-simulation model. (orig.)

  15. Ophthalmology resident surgical competency: a national survey.

    Science.gov (United States)

    Binenbaum, Gil; Volpe, Nicholas J

    2006-07-01

    To describe the prevalence, management, and career outcomes of ophthalmology residents who struggle with surgical competency and to explore related educational issues. Fourteen-question written survey. Fifty-eight program directors at Accreditation Council on Graduate Medical Education-accredited, United States ophthalmology residency programs, representing a total of 2179 resident graduates, between 1991 and 2000. Study participants completed a mailed, anonymous survey whose format combined multiple choice and free comment questions. Number of surgically challenged residents, types of problems identified, types of remediation, final departmental decision at the end of residency, known career outcomes, and residency program use of microsurgical skills laboratories and applicant screening tests. One hundred ninety-nine residents (9% overall; 10% mean per program) were labeled as having trouble mastering surgical skills. All of the programs except 2 had encountered such residents. The most frequently cited problems were poor hand-eye coordination (24%) and poor intraoperative judgment (22%). Most programs were supportive and used educational rather than punitive measures, the most common being extra practice-laboratory time (32%), scheduling cases with the best teaching surgeon (23%), and counseling (21%). Nearly one third (31%) of residents were believed to have overcome their difficulties before graduation. Other residents were encouraged to pursue medical ophthalmology (22%) or to obtain further surgical training through a fellowship (21%) or a supervised practice setting (12%); these residents were granted a departmental statement of satisfactory completion of residency for Board eligibility. Twelve percent were asked to leave residency. Of reported career outcomes, 92% of residents were practicing ophthalmology, 65% as surgical and 27% as medical ophthalmologists. Ninety-eight percent of residency programs had microsurgical practice facilities, 64% had a formal

  16. Use of social media by residency program directors for resident selection.

    Science.gov (United States)

    Cain, Jeff; Scott, Doneka R; Smith, Kelly

    2010-10-01

    Pharmacy residency program directors' attitudes and opinions regarding the use of social media in residency recruitment and selection were studied. A 24-item questionnaire was developed, pilot tested, revised, and sent to 996 residency program directors via SurveyMonkey.com. Demographic, social media usage, and opinions on social media data were collected and analyzed. A total of 454 residency program directors completed the study (response rate, 46.4%). The majority of respondents were women (58.8%), were members of Generation X (75.4%), and worked in a hospital or health system (80%). Most respondents (73%) rated themselves as either nonusers or novice users of social media. Twenty percent indicated that they had viewed a pharmacy residency applicant's social media information. More than half (52%) had encountered e-professionalism issues, including questionable photos and posts revealing unprofessional attitudes, and 89% strongly agreed or agreed that information voluntarily published online was fair game for judgments on character, attitudes, and professionalism. Only 4% of respondents had reviewed applicants' profiles for residency selection decisions. Of those respondents, 52% indicated that the content had no effect on resident selection. Over half of residency program directors were unsure whether they will use social media information for future residency selection decisions. Residency program directors from different generations had different views regarding social media information and its use in residency applicant selections. Residency program directors anticipated using social media information to aid in future decisions for resident selection and hiring.

  17. Internal exposure to trace elements in non-smoking residents living in a northern Taiwan industrial city.

    Science.gov (United States)

    Lin, Tser-Sheng; Wu, Chin-Ching

    2011-12-01

    A total of 94 (54 males, 40 females) healthy adult residents living in an industrial city in northern Taiwan were recruited to study their exposure to industrial metals by measuring their blood levels of V, Cr, Mn, Ni, Co, As, Se, Mo, Cd, Pb, and W. All participants were non-smokers without obvious direct occupational exposure to these elements, although by working in administrative sectors in industrial facilities their indirect or potential exposure was increased. The average concentrations of V, Cr, Mn, Ni, Co, As, Se, Mo, Cd, Pb, and W in blood were 0.30, 1.49, 15.1, 3.84, 2.73, 21.1, 204, 3.2, 0.76, 51.1, and 0.40 ng/mL, respectively. These values were significantly higher than reference values reported for the general population, in some cases exceeding those of occupationally exposed workers. The principal component and correlation analyses among blood element levels suggested that the predominant sources of exposure were glass manufacturing and traffic-related sources. Despite of some limitations, the study demonstrates that the residents in this industrial area may suffer adverse chronic health effects attributable to exposures to these elements.

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

    Science.gov (United States)

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

    2012-01-01

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

  19. Lawful Permanent Residents Fiscal Year 2015 Core Based Statistical Area (CBSA) of Residence

    Data.gov (United States)

    Department of Homeland Security — Lawful permanent residents (LPRs) are foreign nationals who have been granted the right to reside permanently in the United States. LPRs are also known as 'permanent...

  20. Lawful Permanent Residents Fiscal Year 2016 Core Based Statistical Area (CBSA) of Residence

    Data.gov (United States)

    Department of Homeland Security — Lawful permanet residents (LPRs) are foreign nationals who have been gratned the right to reside permanently in the United States. LPRs are also known as 'permanent...

  1. Lawful Permanent Residents Fiscal Year 2011 Core Based Statistical Area (CBSA) of Residence

    Data.gov (United States)

    Department of Homeland Security — Lawful permanent residents (LPRs) are foreign nationals who have been granted the right to reside permanently in the United States. LPRs are also known as 'permanent...

  2. Lawful Permanent Residents Fiscal Year 2014 Core Based Statistical Area (CBSA) of Residence

    Data.gov (United States)

    Department of Homeland Security — Lawful permanent residents (LPRs) are foreign nationals who have been granted the right to reside permanently in the United States. LPRs are also known as 'permanent...

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

    Science.gov (United States)

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

    1996-06-01

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

  4. Parental leave for residents and pediatric training programs.

    Science.gov (United States)

    2013-02-01

    The American Academy of Pediatrics (AAP) is committed to the development of rational, equitable, and effective parental leave policies that are sensitive to the needs of pediatric residents, families, and developing infants and that enable parents to spend adequate and good-quality time with their young children. It is important for each residency program to have a policy for parental leave that is written, that is accessible to residents, and that clearly delineates program practices regarding parental leave. At a minimum, a parental leave policy for residents and fellows should conform legally with the Family Medical Leave Act as well as with respective state laws and should meet institutional requirements of the Accreditation Council for Graduate Medical Education for accredited programs. Policies should be well formulated and communicated in a culturally sensitive manner. The AAP advocates for extension of benefits consistent with the Family Medical Leave Act to all residents and interns beginning at the time that pediatric residency training begins. The AAP recommends that regardless of gender, residents who become parents should be guaranteed 6 to 8 weeks, at a minimum, of parental leave with pay after the infant's birth. In addition, in conformance with federal law, the resident should be allowed to extend the leave time when necessary by using paid vacation time or leave without pay. Coparenting, adopting, or fostering of a child should entitle the resident, regardless of gender, to the same amount of paid leave (6-8 weeks) as a person who takes maternity/paternity leave. Flexibility, creativity, and advanced planning are necessary to arrange schedules that optimize resident education and experience, cultivate equity in sharing workloads, and protect pregnant residents from overly strenuous work experiences at critical times of their pregnancies.

  5. Adult neurology training during child neurology residency.

    Science.gov (United States)

    Schor, Nina F

    2012-08-21

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

  6. 42 CFR 483.10 - Resident rights.

    Science.gov (United States)

    2010-10-01

    ... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED...-determination, and communication with and access to persons and services inside and outside the facility. A... resident both orally and in writing in a language that the resident understands of his or her rights and...

  7. Emotional intelligence in orthopedic surgery residents.

    Science.gov (United States)

    Chan, Kevin; Petrisor, Brad; Bhandari, Mohit

    2014-04-01

    Emotional intelligence (EI) is the ability to understand and manage emotions in oneself and others. It was originally popularized in the business literature as a key attribute for success that was distinct from cognitive intelligence. Increasing focus is being placed on EI in medicine to improve clinical and academic performance. Despite the proposed benefits, to our knowledge, there have been no previous studies on the role of EI in orthopedic surgery. We evaluated baseline data on EI in a cohort of orthopedic surgery residents. We asked all orthopedic surgery residents at a single institution to complete an electronic version of the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). We used completed questionnaires to calculate total EI scores and 4 branch scores. Data were analyzed according to a priori cutoff values to determine the proportion of residents who were considered competent on the test. Data were also analyzed for possible associations with age, sex, race and level of training. Thirty-nine residents (100%) completed the MSCEIT. The mean total EI score was 86 (maximum score 145). Only 4 (10%) respondents demonstrated competence in EI. Junior residents (p = 0.026), Caucasian residents (p = 0.009) and those younger than 30 years (p = 0.008) had significantly higher EI scores. Our findings suggest that orthopedic residents score low on EI based on the MSCEIT. Optimizing resident competency in noncognitive skills may be enhanced by dedicated EI education, training and testing.

  8. Medication Refusal: Resident Rights, Administration Dilemma.

    Science.gov (United States)

    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.

  9. Tax treaty entitlement issues concerning dual residents

    NARCIS (Netherlands)

    Sanghavi, D.

    2014-01-01

    The question whether a dual resident taxpayer is entitled to tax treaties concluded by each residence state with a third state has been controversial. Since 2008, the Organisation for Economic Co-operation and Development (OECD) Commentary on Article 4(1) of the OECD Model states that such a

  10. Displacing Media: LCD LAB Artistic Residency

    Directory of Open Access Journals (Sweden)

    Filipe Pais

    2012-12-01

    Full Text Available This review refers to an artistic residency which took place at LCD LAB -  CAAA at Guimarães, in March, exploring a strategy for media art called Media Displacement. The text introduces the strategy very briefly and describes the residency's organization, structure, processses and the results produced.

  11. 42 CFR 436.403 - State residence.

    Science.gov (United States)

    2010-10-01

    ...) Definition. For purposes of this section—Institution has the same meaning as Institution and Medical... intention to remain there permanently or for an indefinite period. (2) For any individual not residing in an... of residence is the State where the individual is— (i) Living with the intention to remain there...

  12. 42 CFR 435.403 - State residence.

    Science.gov (United States)

    2010-10-01

    ... set forth in § 431.52 of this chapter. (b) Definition. For purposes of this section—Institution has... intent, the State of residence is the State where the individual is living with the intention to remain...), the State of residence is the State where the individual is— (i) Living with the intention to remain...

  13. Teaching Forensic Psychiatry to General Psychiatry Residents

    Science.gov (United States)

    Lewis, Catherine F.

    2004-01-01

    Objective: The Accreditation Council on Graduate Medical Education (ACGME) requires that general psychiatry residency training programs provide trainees with exposure to forensic psychiatry. Limited information is available on how to develop a core curriculum in forensic psychiatry for general psychiatry residents and few articles have been…

  14. How Residents Learn From Patient Feedback: A Multi-Institutional Qualitative Study of Pediatrics Residents' Perspectives.

    Science.gov (United States)

    Bogetz, Alyssa L; Orlov, Nicola; Blankenburg, Rebecca; Bhavaraju, Vasudha; McQueen, Alisa; Rassbach, Caroline

    2018-04-01

    Residents may view feedback from patients and their families with greater skepticism than feedback from supervisors and peers. While discussing patient and family feedback with faculty may improve residents' acceptance of feedback and learning, specific strategies have not been identified. We explored pediatrics residents' perspectives of patient feedback and identified strategies that promote residents' reflection on and learning from feedback. In this multi-institutional, qualitative study conducted in June and July 2016, we conducted focus groups with a purposive sample of pediatrics residents after their participation in a randomized controlled trial in which they received written patient feedback and either discussed it with faculty or reviewed it independently. Focus group transcripts were audiorecorded, transcribed, and analyzed for themes using the constant comparative approach associated with grounded theory. Thirty-six of 92 (39%) residents participated in 7 focus groups. Four themes emerged: (1) residents valued patient feedback but felt it may lack the specificity they desire; (2) discussing feedback with a trusted faculty member was helpful for self-reflection; (3) residents identified 5 strategies faculty used to facilitate their openness to and acceptance of patient feedback (eg, help resident overcome emotional responses to feedback and situate feedback in the context of lifelong learning); and (4) residents' perceptions of feedback credibility improved when faculty observed patient encounters and solicited feedback on the resident's behalf prior to discussions. Discussing patient feedback with faculty provided important scaffolding to enhance residents' openness to and reflection on patient feedback.

  15. Child Neurology Education for Pediatric Residents.

    Science.gov (United States)

    Albert, Dara V F; Patel, Anup D; Behnam-Terneus, Maria; Sautu, Beatriz Cunill-De; Verbeck, Nicole; McQueen, Alisa; Fromme, H Barrett; Mahan, John D

    2017-03-01

    The aim of this study was to evaluate whether the current state of child neurology education during pediatric residency provides adequate preparation for pediatric practice. A survey was sent to recent graduates from 3 pediatric residency programs to assess graduate experience, perceived level of competence, and desire for further education in child neurology. Responses from generalists versus subspecialists were compared. The response rate was 32%, half in general pediatric practice. Only 22% feel very confident in approaching patients with neurologic problems. This may represent the best-case scenario as graduates from these programs had required neurology experiences, whereas review of Accreditation Council of Graduate Medical Education-accredited residency curricula revealed that the majority of residencies do not. Pediatric neurologic problems are common, and pediatric residency graduates do encounter such problems in practice. The majority of pediatricians report some degree of confidence; however, some clear areas for improvement are apparent.

  16. Use of the International Classification of Functioning, Disability and Health Generic-30 Set for the characterization of outpatients: Italian Society of Physical and Rehabilitative Medicine Residents Section Project.

    Science.gov (United States)

    Gimigliano, Francesca; De Sire, Alessandro; Gastaldo, Marco; Maghini, Irene; Paoletta, Marco; Pasquini, Andrea; Boldrini, Paolo; Selb, Melissa; Prodinger, Birgit

    2018-06-11

    The International Classification of Functioning, Disability and Health (ICF) Generic- 30 Set (previously referred to as Rehabilitation Set) is a minimal set of ICF categories for reporting and assessing functioning and disability in clinical populations with different health conditions along the continuum of care. Recently, the Italian Society of Physical and Rehabilitation Medicine (SIMFER) developed an Italian modification of the simple and intuitive descriptions (SID) of these categories. This study was the first one to implement the use of the SID in practice. 1) To implement the use of the ICF in clinical practice and research among Italian Residents in PRM. 2) To verify if the SID made the application of ICF Generic 30 Set more user-friendly than the original descriptions. 3) To examine the prevalence of functioning problems of patients accessing Rehabilitation Services to serve as reference for the development of an ICF-based clinical data collection tool. Multicenter cross-sectional study. Italian Physical Medicine and Rehabilitation (PRM) outpatient rehabilitation services. Patients referring to Italian PRM outpatient rehabilitation services and Italian Residents in PRM. Each School of Specialization involved, randomly, received the ICF Generic-30 Set with the original descriptions or with the SID. Residents collected over a 4-month period (April-July 2016) patients data related to the ICF Generic-30 Set categories. Moreover, the residents self- assessed their difficulty in using the ICF Generic-30 Set with the original descriptions or with the SID, through a Numeric Rating Scale (NRS). Ninety-three residents collected functioning data of 864 patients (mean aged 57.7±19.3) with ICF Generic-30 Set: 304 with the original descriptions and 560 with SID. The difficulty in using the ICF Generic-30 Set with SID was rated as lower than using the original descriptions (NRS = 2.8±2.5 vs 3.5±3.1; p<0.001). The most common disease was the back pain (9.6%) and

  17. Development of a Comprehensive Communication Skills Curriculum for Pediatrics Residents.

    Science.gov (United States)

    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.

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

    Science.gov (United States)

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

    2017-03-01

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

  19. Resident physicians as human information systems: sources yet seekers.

    Science.gov (United States)

    Bass, Ellen J; DeVoge, Justin Michael; Waggoner-Fountain, Linda A; Borowitz, Stephen M

    2013-01-01

    To characterize question types that residents received on overnight shifts and what information sources were used to answer them. Across 30 overnight shifts, questions asked of on-call senior residents, question askers' roles, and residents' responses were documented. External sources were noted. 158 of 397 questions (39.8%) related to the plan of care, 53 (13.4%) to medical knowledge, 48 (12.1%) to taskwork knowledge, and 44 (11.1%) to the current condition of patients. For 351 (88.4%) questions residents provided specific, direct answers or visited the patient. For 16 of these, residents modeled or completed the task. For 216 questions, residents used previous knowledge or their own clinical judgment. Residents solicited external information sources for 118 questions and only a single source for 77 (65.3%) of them. For the 118, most questions concerned either the plan of care or the patient's current condition and were asked by interns and nurses (those with direct patient care responsibilities). Resident physicians serve as an information system and they often specifically answer the question using previous knowledge or their own clinical judgment, suggesting that askers are contacting an appropriately knowledgeable person. However, they do need to access patient information such as the plan of care. They also serve an educator role and answer many knowledge-related questions. As synchronous verbal communications continue to be important pathways for information flow, informaticians need to consider the relationship between such communications and workflow in the development of healthcare support tools.

  20. Evolution of the Pathology Residency Curriculum

    Directory of Open Access Journals (Sweden)

    Wesley Y. Naritoku MD, PhD

    2016-10-01

    Full Text Available The required medical knowledge and skill set for the pathologist of 2020 are different than in 2005. Pathology residency training curriculum must accordingly change to fulfill the needs of these ever-changing requirements. In order to make rational curricular adjustments, it is important for us to know the current trajectory of resident training in pathology—where we have been, what our actual current training curriculum is now—to understand how that might change in anticipation of meeting the needs of a changing patient and provider population and to fit within the evolving future biomedical and socioeconomic health-care setting. In 2013, there were 143 Accreditation Council for Graduate Medical Education-accredited pathology residency training programs in the United States, with approximately 2400 residents. There is diversity among residency training programs not only with respect to the number of residents but also in training venue(s. To characterize this diversity among pathology residency training programs, a curriculum survey was conducted of pathology residency program directors in 2013 and compared with a similar survey taken almost 9 years previously in 2005 to identify trends in pathology residency curriculum. Clinical pathology has not changed significantly in the number of rotations over 9 years; however, anatomic pathology has changed dramatically, with an increase in the number of surgical pathology rotations coupled with a decline in stand-alone autopsy rotations. With ever-expanding medical knowledge that the graduating pathology resident must know, it is necessary to (1 reflect upon what are the critical need subjects, (2 identify areas that have become of lesser importance, and then (3 prioritize training accordingly.

  1. Pregnancy and the Plastic Surgery Resident.

    Science.gov (United States)

    Garza, Rebecca M; Weston, Jane S; Furnas, Heather J

    2017-01-01

    Combining pregnancy with plastic surgery residency has historically been difficult. Two decades ago, 36 percent of plastic surgery program directors surveyed actively discouraged pregnancy among residents, and 33 percent of women plastic surgeons suffered from infertility. Most alarmingly, 26 percent of plastic surgery trainees had had an elective abortion during residency. With increasing numbers of women training in plastic surgery, this historical lack of support for pregnancy deserves further attention. To explore the current accommodations made for the pregnant plastic surgery resident, an electronic survey was sent to 88 plastic surgery program directors in the United States. Fifty-four responded, for a response rate of 61.36 percent. On average, a director trained a total of 7.91 women among 17.28 residents trained over 8.19 years. Of the women residents, 1.43 were pregnant during a director's tenure, with 1.35 of those residents taking maternity leave. An average 1.75 male residents took paternity leave. Approximately one-third of programs had a formal maternity/paternity leave policy (36.54 percent) which, in most cases, was limited to defining allowed weeks of leave, time required to fulfill program requirements, and remuneration during leave. This survey of plastic surgery directors is a first step in defining the challenges training programs face in supporting the pregnant resident. Directors provided comments describing their challenges accommodating an absent resident in a small program and complying with the American Board of Plastic Surgery's required weeks of training per year. A discussion of these challenges is followed by suggested solutions.

  2. Evolution of the Pathology Residency Curriculum

    Science.gov (United States)

    Powell, Suzanne Z.; Black-Schaffer, W. Stephen

    2016-01-01

    The required medical knowledge and skill set for the pathologist of 2020 are different than in 2005. Pathology residency training curriculum must accordingly change to fulfill the needs of these ever-changing requirements. In order to make rational curricular adjustments, it is important for us to know the current trajectory of resident training in pathology—where we have been, what our actual current training curriculum is now—to understand how that might change in anticipation of meeting the needs of a changing patient and provider population and to fit within the evolving future biomedical and socioeconomic health-care setting. In 2013, there were 143 Accreditation Council for Graduate Medical Education-accredited pathology residency training programs in the United States, with approximately 2400 residents. There is diversity among residency training programs not only with respect to the number of residents but also in training venue(s). To characterize this diversity among pathology residency training programs, a curriculum survey was conducted of pathology residency program directors in 2013 and compared with a similar survey taken almost 9 years previously in 2005 to identify trends in pathology residency curriculum. Clinical pathology has not changed significantly in the number of rotations over 9 years; however, anatomic pathology has changed dramatically, with an increase in the number of surgical pathology rotations coupled with a decline in stand-alone autopsy rotations. With ever-expanding medical knowledge that the graduating pathology resident must know, it is necessary to (1) reflect upon what are the critical need subjects, (2) identify areas that have become of lesser importance, and then (3) prioritize training accordingly. PMID:28725779

  3. Enhancing teamwork between chief residents and residency program directors: description and outcomes of an experiential workshop.

    Science.gov (United States)

    McPhillips, Heather A; Frohna, John G; Murad, M Hassan; Batra, Maneesh; Panda, Mukta; Miller, Marsha A; Brigham, Timothy P; Doughty, Robert A

    2011-12-01

    An effective working relationship between chief residents and residency program directors is critical to a residency program's success. Despite the importance of this relationship, few studies have explored the characteristics of an effective program director-chief resident partnership or how to facilitate collaboration between the 2 roles, which collectively are important to program quality and resident satisfaction. We describe the development and impact of a novel workshop that paired program directors with their incoming chief residents to facilitate improved partnerships. The Accreditation Council for Graduate Medical Education sponsored a full-day workshop for residency program directors and their incoming chief residents. Sessions focused on increased understanding of personality styles, using experiential learning, and open communication between chief residents and program directors, related to feedback and expectations of each other. Participants completed an anonymous survey immediately after the workshop and again 8 months later to assess its long-term impact. Participants found the workshop to be a valuable experience, with comments revealing common themes. Program directors and chief residents expect each other to act as a role model for the residents, be approachable and available, and to be transparent and fair in their decision-making processes; both groups wanted feedback on performance and clear expectations from each other for roles and responsibilities; and both groups identified the need to be innovative and supportive of changes in the program. Respondents to the follow-up survey reported that workshop participation improved their relationships with their co-chiefs and program directors. Participation in this experiential workshop improved the working relationships between chief residents and program directors. The themes that were identified can be used to foster communication between incoming chief residents and residency directors and to

  4. Applying Lean Six Sigma methodologies to improve efficiency, timeliness of care, and quality of care in an internal medicine residency clinic.

    Science.gov (United States)

    Fischman, Daniel

    2010-01-01

    Patients' connectedness to their providers has been shown to influence the success of preventive health and disease management programs. Lean Six Sigma methodologies were employed to study workflow processes, patient-physician familiarity, and appointment compliance to improve continuity of care in an internal medicine residency clinic. We used a rapid-cycle test to evaluate proposed improvements to the baseline-identified factors impeding efficient clinic visits. Time-study, no-show, and patient-physician familiarity data were collected to evaluate the effect of interventions to improve clinic efficiency and continuity of medical care. Forty-seven patients were seen in each of the intervention and control groups. The wait duration between the end of triage and the resident-patient encounter was statistically shorter for the intervention group. Trends toward shorter wait times for medical assistant triage and total encounter were also seen in the intervention group. On all measures of connectedness, both the physicians and patients in the intervention group showed a statistically significant increased familiarity with each other. This study shows that incremental changes in workflow processes in a residency clinic can have a significant impact on practice efficiency and adherence to scheduled visits for preventive health care and chronic disease management. This project used a structured "Plan-Do-Study-Act" approach.

  5. Alcoholics Anonymous and other mutual help organizations: Impact of a 45-minute didactic for primary care and categorical internal medicine residents.

    Science.gov (United States)

    Marcovitz, David; Cristello, Julie V; Kelly, John F

    2017-01-01

    Substance use disorders (SUDs) are highly prevalent among primary care patients. One evidence-based, cost-effective referral option is ubiquitous mutual help organizations (MHOs) such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and SMART Recovery; however, little is known about how to effectively increase trainee knowledge and confidence with these referrals. The primary aim of this study was to evaluate whether a single 45-minute combined lecture and role play-based didactic for primary care residents could enhance knowledge, improve attitudes, and bolster confidence in referring patients with addictions to community MHOs. The authors developed a 45-minute lecture and role play addressing the evidence for MHOs, their respective background/content, and how to make effective referrals. Participants were administered a brief survey of their MHO-related knowledge, attitudes, and confidence before and after the session to evaluate the didactic impact. Participants were 55 primary care and categorical internal medicine residents divided among postgraduate year 1 (PGY1; 27.3%), PGY2 (38.2%), and PGY3 (34.5%). They had a mean age of 29 (SD = 2.62); 49% were female, 69% were Caucasian, and 78% reported some religious affiliation. Participants' subjective knowledge about MHOs increased significantly (P didactic. Role play may be a useful supplementary tool in enhancing residents' knowledge and skill in treating patients with SUD.

  6. Comparison of Emergency Medicine Malpractice Cases Involving Residents to Non-Resident Cases.

    Science.gov (United States)

    Gurley, Kiersten L; Grossman, Shamai A; Janes, Margaret; Yu-Moe, C Winnie; Song, Ellen; Tibbles, Carrie D; Shapiro, Nathan I; Rosen, Carlo L

    2018-04-17

    Data are lacking on how emergency medicine (EM) malpractice cases with resident involvement differs from cases that do not name a resident. To compare malpractice case characteristics in cases where a resident is involved (resident case) to cases that do not involve a resident (non-resident case) and to determine factors that contribute to malpractice cases utilizing EM as a model for malpractice claims across other medical specialties. We used data from the Controlled Risk Insurance Company (CRICO) Strategies' division Comparative Benchmarking System (CBS) to analyze open and closed EM cases asserted from 2009-2013. The CBS database is a national repository that contains professional liability data on > 400 hospitals and > 165,000 physicians, representing over 30% of all malpractice cases in the U.S (> 350,000 claims). We compared cases naming residents (either alone or in combination with an attending) to those that did not involve a resident (non-resident cohort). We reported the case statistics, allegation categories, severity scores, procedural data, final diagnoses and contributing factors. Fisher's exact test or t-test was used for comparisons (alpha set at 0.05). Eight hundred and forty-five EM cases were identified of which 732 (87%) did not name a resident (non-resident cases), while 113 (13%) included a resident (resident cases) (Figure 1). There were higher total incurred losses for non-resident cases (Table 1). The most frequent allegation categories in both cohorts were "Failure or Delay in Diagnosis/Misdiagnosis" and "Medical Treatment" (non-surgical procedures or treatment regimens i.e. central line placement). Allegation categories of Safety and Security, Patient Monitoring, Hospital Policy and Procedure and Breach of Confidentiality were found in the non-resident cases. Resident cases incurred lower payments on average ($51,163 vs. $156,212 per case). Sixty six percent (75) of resident vs 57% (415) of non-resident cases were high severity claims

  7. Problematizing the multidisciplinary residency in oncology: a practical teaching protocol from the perspective of nurse residents

    Directory of Open Access Journals (Sweden)

    Myllena Cândida de Melo

    2014-08-01

    Full Text Available Objective: To investigate practical teaching of nurse residents in a multidisciplinary residency in oncology. Method: A qualitative descriptive study grounded in the problematization methodology and its steps, represented by the Maguerez Arch. Data were analyzed using content analysis. Results: Potentiating and limiting elements of the residency guided the design of a practical teaching protocol from the perspective of residents, structured in three stages: Welcoming and ambience; Nursing care for problem situations; and, Evaluation process. Conclusion: Systematization of practical teaching promoted the autonomy of individuals and the approximation of teaching to reality, making residency less strenuous, stressful and distressing.

  8. Residence time and physical processes in lakes

    Directory of Open Access Journals (Sweden)

    Nicoletta SALA

    2003-09-01

    Full Text Available The residence time of a lake is highly dependent on internal physical processes in the water mass conditioning its hydrodynamics; early attempts to evaluate this physical parameter emphasize the complexity of the problem, which depends on very different natural phenomena with widespread synergies. The aim of this study is to analyse the agents involved in these processes and arrive at a more realistic definition of water residence time which takes account of these agents, and how they influence internal hydrodynamics. With particular reference to temperate lakes, the following characteristics are analysed: 1 the set of the lake's caloric components which, along with summer heating, determine the stabilizing effect of the surface layers, and the consequent thermal stratification, as well as the winter destabilizing effect; 2 the wind force, which transfers part of its momentum to the water mass, generating a complex of movements (turbulence, waves, currents with the production of active kinetic energy; 3 the water flowing into the lake from the tributaries, and flowing out through the outflow, from the standpoint of hydrology and of the kinetic effect generated by the introduction of these water masses into the lake. These factors were studied in the context of the general geographical properties of the lake basin and the watershed (latitude, longitude, morphology, also taking account of the local and regional climatic situation. Also analysed is the impact of ongoing climatic change on the renewal of the lake water, which is currently changing the equilibrium between lake and atmosphere, river and lake, and relationships

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

    Science.gov (United States)

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

    2015-01-01

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

  10. Proceedings of the international symposium on environmental monitoring and dose estimation of residents after accident of TEPCO's Fukushima Daiichi Nuclear Power Stations

    International Nuclear Information System (INIS)

    Takahashi, Sentaro; Yamana, Hajimu; Takahashi, Tomoyuki; Takamiya, Koichi; Fukutani, Satoshi; Sato, Nobuhiro; Nakatani, Maki

    2013-02-01

    In March 2011, a massive earthquake and the resulting tsunami struck the Tohoku area in Japan, causing serious damages to TEPCO's Fukushima Daiichi nuclear plant and the release of a significant quantity of radionuclides into the surrounding environment. This accident underlined the necessity of establishing new and comprehensive scientific research for promoting safety in nuclear technology. With this aim, the Kyoto University Research Reactor Institute (KURRI) developed a new research program called the “KUR Research Program for Scientific Basis of Nuclear Safety” from this year. In this program, we are planning to hold an annual series of international symposiums along with many other research activities. The first in this series of symposiums, entitled “The International Symposium on Environmental Monitoring and Dose Estimation of Residents after Accident of TEPCO's Fukushima Daiichi Nuclear Power Station,” deals with the radiological effect of the March 2011 accident in Fukushima Daiichi NPP on the public. The purpose of this symposium is to collate data on environmental radioactivity anadiation dose in residents, discuss and verify these data, and clarify the actual situation of environmental contamination anesultant radiation exposed to the residents. We believe that an accurate estimation of the radiation dose is quite essential for planning for the healthy life and mental contentment of the residents, and we hope that many researchers who are studying the radiological effects of the accident will join us for these purposes. The environmental monitoring data are important for the dose assessment for residents. However, the monitoring data in the early stage are not sufficient for dose assessment, particularly near the NPP site, because of the confusion and blackout caused by the earthquake. However, many researchers and organizations in Japan and other countries have independently carried out radiation monitoring. We believe that the publication and

  11. Problem neurology residents: a national survey.

    Science.gov (United States)

    Tabby, David S; Majeed, Muhammed H; Schwartzman, Robert J

    2011-06-14

    Problem residents are found across most medical specialties at a prevalence of about 10%. This study was designed to explore the prevalence and causes of problem neurology residents and to compare neurology programs' responses and outcomes. Directors of 126 US neurology residency programs were sent an electronic survey. We collected data on demographics, first and all "identifiers" of problem residents, and year of training in which the problem was found. We asked about observable signs, etiology, and who performed remediation. We asked what resources were used and what outcomes occurred. Ninety-five program directors completed surveys (75% response rate). Almost all neurology programs have problem residents (81%). Age, sex, marital status, being a US native, or attending a US medical school had no effect on problem status. Being a parent carried a lower likelihood of problems (32%). Most commonly the problem is acted on during the first year of training. Faculty members without defined educational roles were the most frequent first identifiers. Program directors were the most common remediators. The most common remediation techniques were increasing supervision and assigning a faculty mentor. Graduate medical education office and psychiatric or psychological counseling services were most often used. Eleven percent of problem residents required a program for impaired physicians and 14% required a leave of absence. Sixteen percent were dismissed from their programs. The prevalence of problem residents in neurology is similar to other disciplines, and various resources are available to remediate them.

  12. Do otolaryngology residency applicants relocate for training?

    Science.gov (United States)

    Gebhard, Grant M; Hauser, Leah J; Dally, Miranda J; Weitzenkamp, David A; Cabrera-Muffly, Cristina

    2016-04-01

    To determine whether there is an association between the geographic location of an applicant's undergraduate school, medical school, and residency program among matched otolaryngology residency applicants. Observational. Otolaryngology residency program applications to our institution from 2009 to 2013 were analyzed. The geographic location of each applicant's undergraduate education and medical education were collected. Online public records were queried to determine the residency program location of matched applicants. Applicants who did not match or who attended medical school outside the United States were excluded. Metro area, state, and region were determined according to US Census Bureau definitions. From 2009 to 2013, 1,089 (78%) of 1,405 applicants who matched into otolaryngology residency applied to our institution. The number of subjects who attended medical school and residency in the same geographic region was 241 (22%) for metropolitan area, 305 (28%) for state, and 436 (40%) for region. There was no difference in geographic location retention by gender or couples match status of the subject. United States Medical Licensing Exam step 1 scores correlated with an increased likelihood of subjects staying within the same geographic region (P = .03). Most otolaryngology applicants leave their previous geographic area to attend residency. Based on these data, the authors recommend against giving weight to geography as a factor when inviting applicants to interview. NA. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  13. Canadian residents' perceived manager training needs.

    Science.gov (United States)

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

    2010-01-01

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

  14. Loss aversion and duration of residence

    Directory of Open Access Journals (Sweden)

    Philip S. Morrison

    2016-10-01

    Full Text Available Background: Studies of internal migration ask who moves, why they move, and what are the consequences - to themselves, their origin, and their destination. By contrast, studies of those who stay for very long durations are less common, despite the fact that most people move relatively infrequently. Objective: We argue that staying is the dominant, preferred state and that moving is simply an adjustment toward a desired state of stability (or equilibrium. The core of our argument, already recognized in the literature, is that migration is risky. However, we extend the argument to loss aversion as developed within prospect theory. Prospect theory posits that existing possessions, including the dwelling and existing commodities, are attributed a value well beyond their purchase price and that this extends the average period of staying among the loss-averse. Methods: Applying prospect theory has several challenges, including measurement of the reference point and potential degrees of gain and loss households face in deciding to change residence, as well as their own degree of loss aversion. The growing number of large panel sets should make it possible to estimate the degree to which endowment effects are likely to extend durations of residence as predicted by prospect theory. Conclusions: Rational expectations models of mobility focus on the changes in the level of consumption of residential services. By contrast, prospect theory focuses on potential gains and losses relative to the existing dwelling - the reference point. As we confront increasing durations of residence in contemporary society, an application of prospect theory is likely to yield important advantages over existing models of mobility and staying.

  15. Program for developing leadership in pharmacy residents.

    Science.gov (United States)

    Fuller, Patrick D

    2012-07-15

    An innovative, structured approach to incorporating leadership development activities into pharmacy residency training is described. The American Society of Health-System Pharmacists (ASHP) has called for increased efforts to make leadership development an integral component of the training of pharmacy students and new practitioners. In 2007, The Nebraska Medical Center (TNMC) took action to systematize leadership training in its pharmacy residency programs by launching a new Leadership Development Series. Throughout the residency year, trainees at TNMC participate in a variety of activities: (1) focused group discussions of selected articles on leadership concepts written by noted leaders of the past and present, (2) a two-day offsite retreat featuring trust-building exercises and physical challenges, (3) a self-assessment designed to help residents identify and use their untapped personal strengths, (4) training on the effective application of different styles of communication and conflict resolution, and (5) education on the history and evolution of health-system pharmacy, including a review and discussion of lectures by recipients of ASHP's Harvey A. K. Whitney Award. Feedback from residents who have completed the series has been positive, with many residents indicating that it has stimulated their professional growth and helped prepared them for leadership roles. A structured Leadership Development Series exposes pharmacy residents to various leadership philosophies and principles and, through the study of Harvey A. K. Whitney Award lectures, to the thoughts of past and present pharmacy leaders. Residents develop an increased self-awareness through a resident fall retreat, a StrengthsFinder assessment, and communication and conflict-mode assessment tools.

  16. 26 CFR 25.2702-5 - Personal residence trusts.

    Science.gov (United States)

    2010-04-01

    ... a portion of the residence is used in an activity meeting the requirements of section 280A(c) (1) or... provision of lodging (e.g. a hotel or a bed and breakfast). A residence is not a personal residence if... portion of their interests in the residence) to the same personal residence trust, provided that the...

  17. 26 CFR 1.6049-8 - Interest and original issue discount paid to residents of Canada.

    Science.gov (United States)

    2010-04-01

    ... residents of Canada. 1.6049-8 Section 1.6049-8 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE... original issue discount paid to residents of Canada. (a) Interest subject to reporting requirement. For... nonresident alien individual is an individual who resides in Canada and is not a United States citizen. The...

  18. Negotiations of Acknowledgement among Middle Class Residents

    DEFF Research Database (Denmark)

    Andersen, Nina Blom

    2013-01-01

    The article presents an analysis of communication processes between residents, between residents and people in the broader societal context as well as of media coverage of a fireworks disaster in a Danish suburb. It demonstrates how residents (all members of the Danish middle class) were able......, ethnicity, class or other social categories normally recognized as influential in case of disastrous events. Since the population in the area was very homogenous, the axis of differentiation was instead linked to the social category of affectedness, and a hierarchy of affectedness was identified within...

  19. Continuous Certification Within Residency: An Educational Model.

    Science.gov (United States)

    Rachlin, Susan; Schonberger, Alison; Nocera, Nicole; Acharya, Jay; Shah, Nidhi; Henkel, Jacqueline

    2015-10-01

    Given that maintaining compliance with Maintenance of Certification is necessary for maintaining licensure to practice as a radiologist and provide quality patient care, it is important for radiology residents to practice fulfilling each part of the program during their training not only to prepare for success after graduation but also to adequately learn best practices from the beginning of their professional careers. This article discusses ways to implement continuous certification (called Continuous Residency Certification) as an educational model within the residency training program. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

  20. Local Attitudes Towards AN International Project: a Study of Residents' Attitudes Towards a Future High Speed Rail Line in General and Towards Annoyance in Particular

    Science.gov (United States)

    Schaap, D.

    1996-05-01

    Plans for a high speed rail line in Holland generate concerns about the impact on the living environment. Residents living near the planned track have an extremely negative attitude towards the high speed rail line. Most of them do not see the need for the line and they expect a great deal of noise annoyance. There is a disparity between the expectations of the residents and those of the government: the residents expect much more noise that the government does, on the basis of scientific research. The image that residents have of the noise of a high speed train is probably too negative. Therefore the government should supply the residents with better and more detailed information about the noise and the possible annoyance. Furthermore, for a positive attitude, it is important that residents not only recognize the disadvantages of the rail line, but that they recognize some local advantages too. For instances, the government can guarantee compensation for the affected green space, or that other noise sources will be removed. Finally, the residents have the feeling they cannot influence the decision-making process. To reduce this feeling of powerlessness, the government can involve the residents; for example, in the decision-making about the local plans for the high speed rail line.

  1. Description of an ethics curriculum for a medicine residency program.

    OpenAIRE

    Silverman, H J

    1999-01-01

    This paper examines the attempts to develop and implement an ethics curriculum for the Internal Medicine Residency Program at the University of Maryland Medical Center. The objectives of the curriculum were to enhance moral reasoning skills and to promote humanistic attitudes and behavior among the residents. The diverse methodologies used to achieve these objectives included case discussions, literature reading, role playing, writing, and videos. These activities occurred predominantly withi...

  2. Methodical approach to reconstruct individual internal doses for persons residing in areas of Belarus contaminated as a result of the Chernobyl accident

    International Nuclear Information System (INIS)

    Skryabin, Anatoly; Belsky, Yuri

    2008-01-01

    Full text: The studies on the risk to population of low-level exposure following the Chernobyl accident require the estimation of the individual doses. The most difficult aspect is the estimation of internal exposure (IAED int ). Level of individual internal exposure due to ingestion of long-lived caesium isotopes defines by individual 'food habits' (IFH) of the person. Non-standard methodical approach is suggested to evaluate internal doses taking into IFH: 1) IFH are generally conservative by food characteristic and steady in time; 2) IFH of the person determines his dose which can be calculated using data of personal interview and the special table of conformity establishing connection between IFH and corresponding percentile interval in a variation line of doses in given settlement; 3) IAED int (1986-2005) is calculated as the sum of annual doses of the individual for all period of exposure and in all settlements of residing. To develop the model, WBC measurements data (around 1.5 millions) collected in 1987-2005 for population of around 1000 Belarusian settlements were used. The input data for IAEA int calculation include consumption of dose-significant products, duration, and place of residence obtained by mean of individual questionnaire; WBC measurements data; table of conformity (IFH → IAED int ). (author)

  3. [Fifty years of residency in Psychiatry at the University of Montreal: relevance and necessity of the Residents' Association].

    Science.gov (United States)

    Thibault, Alexis

    2015-01-01

    In the context of the fiftieth anniversary celebrations of the Département de psychiatrie de l'Université de Montréal, the present article offers to retrace the history of the Psychiatry Resident's Association (ARPUM). Since the Association's activities and demands reflected the concerns of the time, a depiction of the Residency Program and exploration of the historical and administrative context, in each key period, is also undertaken. Multiple psychiatrists from every decade, who were once active members of the Association, were interviewed and asked to describe the Residency Program at their time, with its positive and negative aspects, based on their own personal experience as a resident, but also as a member of the organization. The interviewees were also invited to share their recollections of the various Association's demands, representations, activities and functioning, depending on the issues and periods. Various private and public archives were also used, in order to contextualize the residents' experiences and the Association's work. A brief exploration of the historical and political context that led to the creation of the organization is explained. Training and working conditions of residents at that time are reported, enabling the understanding of the first demands when the group was born. Historical jumps are then proposed, from decades to decades, in order to depict key issues, whether they were academic, clinical or organizational, through which the Association worked, over the evolution of the Residency Program. The internal functioning and its occasional problems throughout the years are also described, as is the role in organizing social and educational events. The Residency Program is in constant mutation, and the Association has played its part in shaping the psychiatric training at the Université de Montréal. Multiple positive and tangible impacts were and are still made possible from the collaborative work between the Département de

  4. Resident and attending physician perception of maladaptive response to stress in residents

    Directory of Open Access Journals (Sweden)

    Lee Ann Riesenberg

    2014-11-01

    Full Text Available Background: Residency stress has been shown to interfere with resident well-being and patient safety. We developed a survey research study designed to explore factors that may affect perception of a maladaptive response to stress. Methods: A 16-item survey with 12 Likert-type perception items was designed to determine how often respondents agreed or disagreed with statements regarding the resident on the trigger tape. A total of 438 respondents from multiple institutions completed surveys. Results: Attending physicians were more likely than residents to agree that the resident on the trigger tape was impaired, p<0.0001; needed to seek professional counseling, p=0.0003; should be removed from the service, p=0.002; was not receiving adequate support from the attending physician, p=0.007; and was a risk to patient safety, p=0.02. Attending physicians were also less likely to agree that the resident was a good role model, p=0.001, and that the resident should be able to resolve these issues herself/himself, p<0.0001. Conclusion: Our data suggest that resident physicians may not be able to adequately detect maladaptive responses to stress and that attending physicians may be more adept at recognizing this problem. More innovative faculty and resident development workshops should be created to teach and encourage physicians to better observe and detect residents who are displaying maladaptive responses to stress.

  5. Changes in Personal Relationships During Residency and Their Effects on Resident Wellness: A Qualitative Study.

    Science.gov (United States)

    Law, Marcus; Lam, Michelle; Wu, Diana; Veinot, Paula; Mylopoulos, Maria

    2017-11-01

    Residency poses challenges for residents' personal relationships. Research suggests residents rely on family and friends for support during their training. The authors explored the impact of residency demands on residents' personal relationships and the effects changes in those relationships could have on their wellness. The authors used a constructivist grounded theory approach. In 2012-2014, they conducted semistructured interviews with a purposive and theoretical sample of 16 Canadian residents from various specialties and training levels. Data analysis occurred concurrently with data collection, allowing authors to use a constant comparative approach to explore emergent themes. Transcripts were coded; codes were organized into categories and then themes to develop a substantive theory. Residents perceived their relationships to be influenced by their evolving professional identity: Although personal relationships were important, being a doctor superseded them. Participants suggested they were forced to adapt their personal relationships, which resulted in the evolution of a hierarchy of relationships that was reinforced by the work-life imbalance imposed by their training. This poor work-life balance seemed to result in relationship issues and diminish residents' wellness. Participants applied coping mechanisms to manage the conflict arising from the adaptation and protect their relationships. To minimize the effects of identity dissonance, some gravitated toward relationships with others who shared their professional identity or sought social comparison as affirmation. Erosion of personal relationships could affect resident wellness and lead to burnout. Educators must consider how educational programs impact relationships and the subsequent effects on resident wellness.

  6. Perspectives of Residents of Mashhad School of Dentistry about the Curriculum of Residency Program

    Directory of Open Access Journals (Sweden)

    Javad Sarabadani

    2015-09-01

    Full Text Available Introduction: This study was carried out to analyze the viewpoint of the residents of school of dentistry about the curriculum presented in the residency program to students of Mashhad School of Dentistry. Methods: To evaluate the perspectives of residents of dental school about the curriculum and regulations of residency program, a questionnaire was designed whose validity and reliability were confirmed by the authorities of School of Dentistry and test-retest reliability, respectively. The questionnaire was distributed among 100 residents and 80 of them completed the questionnaires. The data were analyzed by SPSS software (version 11.5. Results: A total of 43% of residents were informed of the curriculum (e.g. academic leave, transfer, removal of semester, etc.. As for the ability to write research proposal, 42.7% of residents were reported to have a favorable status, i.e. they were able to write more than 80% of their proposal. From among the residents, 30.4% had specialized English language certificate. Most of them (77% were satisfied with the professional staff, faculty members, of the faculty. Many students liked to participate in the teaching method courses of the residency program. Conclusion: Residents maintained that the curriculum in such domains as educational and research issues and special capabilities had some weak points. Thus, appropriate strategies are recommended to be applied to revise the curriculum using the residents’ views on these programs.

  7. Confidence, knowledge, and skills at the beginning of residency. A survey of pathology residents.

    Science.gov (United States)

    Hsieh, Cindy M; Nolan, Norris J

    2015-01-01

    To document the pathology learning experiences of pathology residents prior to residency and to determine how confident they were in their knowledge and technical skills. An online survey was distributed to all pathology residency program directors in the United States, who were requested to forward the survey link to their residents. Data were obtained on pathology electives, grossing experience, and frozen section experience. Likert scale questions assessed confidence level in knowledge and skills. In total, 201 pathology residents responded (8% of residents in the United States). Prior to starting residency, most respondents had exposure to anatomic pathology through elective rotations. Few respondents had work-related experience. Most did not feel confident in their pathology-related knowledge or skills, and many did not understand what pathology resident duties entail. Respondents gained exposure to pathology primarily through elective rotations, and most felt the elective experience prepared them for pathology residency. However, elective time may be enhanced by providing opportunities for students to increase hands-on experience and understanding of resident duties. Copyright© by the American Society for Clinical Pathology.

  8. Anesthesiology resident personality type correlates with faculty assessment of resident performance.

    Science.gov (United States)

    Schell, Randall M; Dilorenzo, Amy N; Li, Hsin-Fang; Fragneto, Regina Y; Bowe, Edwin A; Hessel, Eugene A

    2012-11-01

    To study the association between anesthesiology residents' personality preference types, faculty evaluations of residents' performance, and knowledge. Convenience sample and prospective study. Academic department of anesthesiology. Consenting anesthesiology residents (n = 36). All participants completed the Myers Briggs Type Indicator® (MBTI®). All residents' 6-month summation of daily focal evaluations completed by faculty [daily performance score (DPS); 1 = unsatisfactory, 2 = needs improvement, 3 = meets expectations, 4 = exceeds expectations], as well as a global assessment of performance (GAP) score based on placement of each resident into perceived quartile compared with their peers (ie,1 = first, or top, quartile) by senior faculty (n = 7) who also completed the MBTI, were obtained. The resident MBTI personality preferences were compared with the DPS and GAP scores, the United States Medical Licensing Examination (USMLE) I and II scores, and faculty MBTI personality type. There was no association between personality preference type and performance on standardized examinations (USMLE I, II). The mean GAP score was better (higher quartile score) for Extraverts than Introverts (median 2.0 vs 2.6, P = 0.0047) and for Sensing versus Intuition (median 2.0 vs 2.6, P = 0.0206) preference. Faculty evaluator MBTI preference type did not influence the GAP scores they assigned residents. Like GAP, the DPS was better for residents with Sensing versus Intuition preference (median 3.5 vs 3.3, P = 0.0111). No difference in DPS was noted between Extraverts and Introverts. Personality preference type was not associated with resident performance on standardized examinations, but it was associated with faculty evaluations of resident performance. Residents with Sensing personality preference were evaluated more favorably on global and focal faculty evaluations than those residents who chose the Intuition preference. Extraverted residents were evaluated more favorably on

  9. Identifying Gaps and Launching Resident Wellness Initiatives: The 2017 Resident Wellness Consensus Summit.

    Science.gov (United States)

    Zaver, Fareen; Battaglioli, Nicole; Denq, William; Messman, Anne; Chung, Arlene; Lin, Michelle; Liu, Emberlynn L

    2018-03-01

    Burnout, depression, and suicidality among residents of all specialties have become a critical focus for the medical education community, especially among learners in graduate medical education. In 2017 the Accreditation Council for Graduate Medical Education (ACGME) updated the Common Program Requirements to focus more on resident wellbeing. To address this issue, one working group from the 2017 Resident Wellness Consensus Summit (RWCS) focused on wellness program innovations and initiatives in emergency medicine (EM) residency programs. Over a seven-month period leading up to the RWCS event, the Programmatic Initiatives workgroup convened virtually in the Wellness Think Tank, an online, resident community consisting of 142 residents from 100 EM residencies in North America. A 15-person subgroup (13 residents, two faculty facilitators) met at the RWCS to develop a public, central repository of initiatives for programs, as well as tools to assist programs in identifying gaps in their overarching wellness programs. An online submission form and central database of wellness initiatives were created and accessible to the public. Wellness Think Tank members collected an initial 36 submissions for the database by the time of the RWCS event. Based on general workplace, needs-assessment tools on employee wellbeing and Kern's model for curriculum development, a resident-based needs-assessment survey and an implementation worksheet were created to assist residency programs in wellness program development. The Programmatic Initiatives workgroup from the resident-driven RWCS event created tools to assist EM residency programs in identifying existing initiatives and gaps in their wellness programs to meet the ACGME's expanded focus on resident wellbeing.

  10. Identifying Gaps and Launching Resident Wellness Initiatives: The 2017 Resident Wellness Consensus Summit

    Directory of Open Access Journals (Sweden)

    Nicole Battaglioli

    2018-02-01

    Full Text Available Introduction: Burnout, depression, and suicidality among residents of all specialties have become a critical focus for the medical education community, especially among learners in graduate medical education. In 2017 the Accreditation Council for Graduate Medical Education (ACGME updated the Common Program Requirements to focus more on resident wellbeing. To address this issue, one working group from the 2017 Resident Wellness Consensus Summit (RWCS focused on wellness program innovations and initiatives in emergency medicine (EM residency programs. Methods: Over a seven-month period leading up to the RWCS event, the Programmatic Initiatives workgroup convened virtually in the Wellness Think Tank, an online, resident community consisting of 142 residents from 100 EM residencies in North America. A 15-person subgroup (13 residents, two faculty facilitators met at the RWCS to develop a public, central repository of initiatives for programs, as well as tools to assist programs in identifying gaps in their overarching wellness programs. Results: An online submission form and central database of wellness initiatives were created and accessible to the public. Wellness Think Tank members collected an initial 36 submissions for the database by the time of the RWCS event. Based on general workplace, needs-assessment tools on employee wellbeing and Kern’s model for curriculum development, a resident-based needs-assessment survey and an implementation worksheet were created to assist residency programs in wellness program development. Conclusion: The Programmatic Initiatives workgroup from the resident-driven RWCS event created tools to assist EM residency programs in identifying existing initiatives and gaps in their wellness programs to meet the ACGME’s expanded focus on resident wellbeing.

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

    Science.gov (United States)

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

    1997-01-01

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

  12. A theory-informed, process-oriented Resident Scholarship Program

    Science.gov (United States)

    Thammasitboon, Satid; Darby, John B.; Hair, Amy B.; Rose, Karen M.; Ward, Mark A.; Turner, Teri L.; Balmer, Dorene F.

    2016-01-01

    Background The Accreditation Council for Graduate Medical Education requires residency programs to provide curricula for residents to engage in scholarly activities but does not specify particular guidelines for instruction. We propose a Resident Scholarship Program that is framed by the self-determination theory (SDT) and emphasize the process of scholarly activity versus a scholarly product. Methods The authors report on their longitudinal Resident Scholarship Program, which aimed to support psychological needs central to SDT: autonomy, competence, and relatedness. By addressing those needs in program aims and program components, the program may foster residents’ intrinsic motivation to learn and to engage in scholarly activity. To this end, residents’ engagement in scholarly processes, and changes in perceived autonomy, competence, and relatedness were assessed. Results Residents engaged in a range of scholarly projects and expressed positive regard for the program. Compared to before residency, residents felt more confident in the process of scholarly activity, as determined by changes in increased perceived autonomy, competence, and relatedness. Scholarly products were accomplished in return for a focus on scholarly process. Conclusions Based on our experience, and in line with the SDT, supporting residents’ autonomy, competence, and relatedness through a process-oriented scholarship program may foster the curiosity, inquisitiveness, and internal motivation to learn that drives scholarly activity and ultimately the production of scholarly products. PMID:27306995

  13. Challenges of pediatric residency training in Taiwan.

    Science.gov (United States)

    Tsai, Tsuen-Chiuan; Harasym, Peter H

    2006-01-01

    A crisis in pediatric residency training today has raised serious concerns about the healthcare quality for children in Taiwan. The purpose of this study was to document the problems and to propose possible solutions for improvement. The problems include: 1) manpower shortage due to the difficulty of recruiting pediatric residents; 2) heavy workload that hinders learning; 3) lack of assessment and poor program planning; and 4) inadequate institutional and financial support. As a result, physicians' competencies are not guaranteed at the end of residency training, even with the pediatric board certification. Possible solutions may include: 1) conducting research on physician manpower statistics, work hours and environment; 2) establishing a Residency Program Review Committee and provision of standards for accreditation; 3) defining the competencies mandated as a general pediatrician and developing a set of measurable qualitative standards; 4) encouraging new programs with flexibility (e.g., primary care); and 5) pursuing adequate institutional and financial supports.

  14. Resident Station Contact Information for Application Developers

    Data.gov (United States)

    Social Security Administration — SSA provides a web service and downloadable file for SSA Resident Station locations, telephone numbers, and hours of operation. (Note: If you think an office might...

  15. Thermal discharge residence by Lake Michigan Salmonids

    International Nuclear Information System (INIS)

    Romberg, G.P.; Prepejchal, W.

    1975-01-01

    Lake Michigan salmon and trout were tagged with a thermoluminescent dosimeter (TLD) temperature tag to estimate their thermal exposure and residence time at a warm water discharge. Fish were collected, tagged, and released at the Point Beach Nuclear Plant, Two Rivers, Wisconsin, in the fall of 1973 and 1974. Tags were recovered during the same season, primarily from fish recaptured at Point Beach. Average uniform temperature exposure and maximum possible discharge residence time were determined. Appropriate hourly intake and discharge temperatures were averaged to calculate mean temperature exposure for the case of maximum discharge residence. Lowest discharge temperature not included within the period of maximum residence was identified to serve as a possible indicator of avoidance temperature. Mean values for the above parameters were calculated for fish species for each tagging year and are reported with the accompanying range of intake and discharge temperatures

  16. Knowledge and Utilization of Electrocardiogram among Resident ...

    African Journals Online (AJOL)

    2017-10-26

    Oct 26, 2017 ... knowledge and utilization of ECG among family medicine residents in Nigeria. Materials and ... doctors regarding their ECG requests, preferred source of interpretation, most common ECG ..... There are no conflicts of interest.

  17. Introducing "optimal challenges" in resident training

    DEFF Research Database (Denmark)

    Sørensen, Anette Bagger; Christensen, Mette Krogh

    Background: Residents are often caught between two interests: the resident’s desire to participate in challenging learning situations and the department’s work planning. However, these interests may clash if they are not coordinated by the senior doctors, and challenging learning situations risk...... that the residents benefit from the intervention because they experienced more optimal challenges than before the intervention. However, the matching of resident and case seems to work against the established culture in the department: The daily work has for many years been organized so that senior doctors have...... their “own” patients and they do not “share” patients with residents. Thus the patients were accustomed to have their “own” specialist doctor. Conclusion: The intervention generated optimal challenges, but revealed the need for more team-based organization of senior doctors and residents’ working...

  18. Request by the Resident Representative of Iraq

    International Nuclear Information System (INIS)

    1990-01-01

    The attached clarification by a spokesman of the Iraqi Ministry of Foreign Affairs is being circulated for the information of Member States pursuant to a request made by the Resident Representative of Iraq

  19. General Surgery Resident Satisfaction on Cardiothoracic Rotations.

    Science.gov (United States)

    Lussiez, Alisha; Bevins, Jack; Plaska, Andrew; Rosin, Vadim; Reddy, Rishindra M

    2016-01-01

    General surgery residents' exposure to cardiothoracic (CT) surgery rotations has decreased, which may affect resident satisfaction. We surveyed general surgery graduates to assess the relationships among rotation satisfaction, CT disease exposure, rotation length, mentorship, and mistreatment. A survey assessing CT curriculum, exposure, mentorship, and satisfaction was forwarded to general surgery graduates from 17 residency programs. A Wilcoxon rank-sum test was used to assess statistical significance of ordinal level data. Statistical significance was defined as p surgery residency programs who graduated between the years of 1999 to 2014. A total of 94 responses were completed and received. Receiving adequate exposure to CT procedures and disease management was significantly associated with higher satisfaction ratings for all procedures, particularly thoracotomy incisions (p Surgery. Published by Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Uzuner Arzu

    2010-04-01

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

  1. Mobile technology in radiology resident education.

    Science.gov (United States)

    Korbage, Aiham C; Bedi, Harprit S

    2012-06-01

    The authors hypothesized that ownership of a mobile electronic device would result in more time spent learning radiology. Current trends in radiology residents' studying habits, their use of electronic and printed radiology learning resources, and how much of the funds allotted to them are being used toward printed vs electronic education tools were assessed in this study. A survey study was conducted among radiology residents across the United States from June 13 to July 5, 2011. Program directors listed in the Association of Program Directors in Radiology e-mail list server received an e-mail asking for residents to participate in an online survey. The questionnaire consisted of 12 questions and assessed the type of institution, the levels of training of the respondents, and book funds allocated to residents. It also assessed the residents' study habits, access to portable devices, and use of printed and electronic radiology resources. Radiology residents are adopters of new technologies, with 74% owning smart phones and 37% owning tablet devices. Respondents spend nearly an equal amount of time learning radiology from printed textbooks as they do from electronic resources. Eighty-one percent of respondents believe that they would spend more time learning radiology if provided with tablet devices. There is considerable use of online and electronic resources and mobile devices among the current generation of radiology residents. Benefits, such as more study time, may be obtained by radiology programs that incorporate tablet devices into the education of their residents. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  2. The urology residency matching program in practice.

    Science.gov (United States)

    Teichman, J M; Anderson, K D; Dorough, M M; Stein, C R; Optenberg, S A; Thompson, I M

    2000-06-01

    We evaluate behaviors and attitudes among resident applicants and program directors related to the American Urological Association (AUA) residency matching program and recommend changes to improve the match. Written questionnaires were mailed to 519 resident applicants and 112 program directors after the 1999 American Urological Association match. Subjects were asked about their observations, behaviors and opinions towards the match. Questionnaires were returned by 230 resident applicants and 94 program directors (44% and 83% response rates, respectively.) Of the resident applicants 75% spent $1,001 to $5,000 for interviewing. Of the program directors 47% recalled that applicants asked how programs would rank the applicant and 61% of applicants recalled that program directors asked applicants how they would rank programs. Dishonesty was acknowledged by 31% of program directors and 44% of resident applicants. Of program directors 82% thought applicants "lied", while 67% of applicants thought that programs "lied" (quotations indicate questionnaire language). Participants characterized their own dishonesty as "just playing the game" or they "did not feel badly." Of program directors 81% and of applicants 61% were "skeptical" or "did not believe" when informed they were a "high" or "number 1" selection. Being asked about marital status was recalled by 91% of male and 100% of female (p = 0. 02), if they had children by 53% of male and 67% of female, (p = 0. 03), and intent to have children by 25% of male and 62% of female (p match code rules frequently. Program directors and resident applicants are skeptical of each other. Patterns of faculty behavior differ based on applicant gender. Interviews are costly for applicants. We recommend that 1) programs adopt policies to enhance fairness, 2) applications be filed electronically, 3) programs assist resident applicants with interview accommodation to reduce financial burden and 4) a post-interview code of limited or

  3. Informatics and Technology in Resident Education.

    Science.gov (United States)

    Niehaus, William

    2017-05-01

    Biomedical or clinical informatics is the transdisciplinary field that studies and develops effective uses of biomedical data, information technology innovations, and medical knowledge for scientific inquiry, problem solving, and decision making, with an emphasis on improving human health. Given the ongoing advances in information technology, the field of informatics is becoming important to clinical practice and to residency education. This article will discuss how informatics is specifically relevant to residency education and the different ways to incorporate informatics into residency education, and will highlight applications of current technology in the context of residency education. How informatics can optimize communication for residents, promote information technology use, refine documentation techniques, reduce medical errors, and improve clinical decision making will be reviewed. It is hoped that this article will increase faculty and trainees' knowledge of the field of informatics, awareness of available technology, and will assist practitioners to maximize their ability to provide quality care to their patients. This article will also introduce the idea of incorporating informatics specialists into residency programs to help practitioners deliver more evidenced-based care and to further improve their efficiency. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  4. Thoracic surgical resident education: a costly endeavor.

    Science.gov (United States)

    Calhoon, John H; Baisden, Clint; Holler, Ben; Hicks, George L; Bove, Ed L; Wright, Cameron D; Merrill, Walter H; Fullerton, Dave A

    2014-12-01

    We sought to define an accurate measure of thoracic surgical education costs. Program directors from six distinct and differently sized and geographically located thoracic surgical training programs used a common template to provide estimates of resident educational costs. These data were reviewed, clarifying questions or discrepancies when noted and using best estimates when exact data were unavailable. Subsequently, a composite of previously published cost-estimation products was used to capture accurate cost data. Data were then compiled and averaged to provide an accurate picture of all costs associated with thoracic surgical education. Before formal accounting was performed, the estimated average for all programs was approximately $250,000 per year per resident. However, when formal evaluations by the six programs were performed, the annual cost of resident education ranged from $330,000 to $667,000 per year per resident. The average cost of $483,000 per year was almost double the initial estimates. Variability was noted by region and size of program. Faculty teaching costs varied from $208,000 to $346,000 per year. Simulation costs ranged from $0 to $80,000 per year. Resident savings to program ranged from $0 to $135,000 per year and averaged $37,000 per year per resident. Thoracic surgical education costs are considerably higher than initial estimates from program directors and probably represent an unappreciated source of financial burden for cardiothoracic surgical educational programs. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  5. The Resident Academic Project Program: A Structured Approach to Inspiring Academic Development During Residency Training.

    Science.gov (United States)

    Eckert, Jill; Vaida, Sonia J; Bezinover, Dmitri; McCloskey, Diane E; Mets, Berend

    2016-02-15

    We report the successful implementation of structured resident academic projects in our Department of Anesthesiology at the Penn State Hershey Medical Center. Beginning with the graduating class of 2010, we adopted an expectation that each resident complete a project that results in a manuscript of publishable quality. Defining a clear timeline for all steps in the project and providing research education, as well as the necessary infrastructure and ongoing support, has helped grow the academic productivity of our anesthesia residents.

  6. Changes in Personal Relationships During Residency and Their Effects on Resident Wellness: A Qualitative Study

    OpenAIRE

    Law, Marcus; Lam, Michelle; Wu, Diana; Veinot, Paula; Mylopoulos, Maria

    2017-01-01

    Purpose Residency poses challenges for residents’ personal relationships. Research suggests residents rely on family and friends for support during their training. The authors explored the impact of residency demands on residents’ personal relationships and the effects changes in those relationships could have on their wellness. Method The authors used a constructivist grounded theory approach. In 2012–2014, they conducted semistructured interviews with a purposive and theoretical sample of 1...

  7. Orthopedic resident work-shift analysis: are we making the best use of resident work hours?

    Science.gov (United States)

    Hamid, Kamran S; Nwachukwu, Benedict U; Hsu, Eugene; Edgerton, Colston A; Hobson, David R; Lang, Jason E

    2014-01-01

    Surgery programs have been tasked to meet rising demands in patient surgical care while simultaneously providing adequate resident training in the midst of increasing resident work-hour restrictions. The purpose of this study was to quantify orthopedic surgery resident workflow and identify areas needing improved resident efficiency. We hypothesize that residents spend a disproportionate amount of time involved in activities that do not relate directly to patient care or maximize resident education. We observed 4 orthopedic surgery residents on the orthopedic consult service at a major tertiary care center for 72 consecutive hours (6 consecutive shifts). We collected minute-by-minute data using predefined work-task criteria: direct new patient contact, direct existing patient contact, communications with other providers, documentation/administrative time, transit time, and basic human needs. A seventh category comprised remaining less-productive work was termed as standby. In a 720-minute shift, residents spent on an average: 191 minutes (26.5%) performing documentation/administrative duties, 167.0 minutes (23.2%) in direct contact with new patient consults, 129.6 minutes (17.1%) in communication with other providers regarding patients, 116.2 (16.1%) minutes in standby, 63.7 minutes (8.8%) in transit, 32.6 minutes (4.5%) with existing patients, and 20 minutes (2.7%) attending to basic human needs. Residents performed an additional 130 minutes of administrative work off duty. Secondary analysis revealed residents were more likely to perform administrative work rather than directly interact with existing patients (p = 0.006) or attend to basic human needs (p = 0.003). Orthopedic surgery residents spend a large proportion of their time performing documentation/administrative-type work and their workday can be operationally optimized to minimize nonvalue-adding tasks. Formal workflow analysis may aid program directors in systematic process improvements to better align

  8. Does resident ranking during recruitment accurately predict subsequent performance as a surgical resident?

    Science.gov (United States)

    Fryer, Jonathan P; Corcoran, Noreen; George, Brian; Wang, Ed; Darosa, Debra

    2012-01-01

    While the primary goal of ranking applicants for surgical residency training positions is to identify the candidates who will subsequently perform best as surgical residents, the effectiveness of the ranking process has not been adequately studied. We evaluated our general surgery resident recruitment process between 2001 and 2011 inclusive, to determine if our recruitment ranking parameters effectively predicted subsequent resident performance. We identified 3 candidate ranking parameters (United States Medical Licensing Examination [USMLE] Step 1 score, unadjusted ranking score [URS], and final adjusted ranking [FAR]), and 4 resident performance parameters (American Board of Surgery In-Training Examination [ABSITE] score, PGY1 resident evaluation grade [REG], overall REG, and independent faculty rating ranking [IFRR]), and assessed whether the former were predictive of the latter. Analyses utilized Spearman correlation coefficient. We found that the URS, which is based on objective and criterion based parameters, was a better predictor of subsequent performance than the FAR, which is a modification of the URS based on subsequent determinations of the resident selection committee. USMLE score was a reliable predictor of ABSITE scores only. However, when we compared our worst residence performances with the performances of the other residents in this evaluation, the data did not produce convincing evidence that poor resident performances could be reliably predicted by any of the recruitment ranking parameters. Finally, stratifying candidates based on their rank range did not effectively define a ranking cut-off beyond which resident performance would drop off. Based on these findings, we recommend surgery programs may be better served by utilizing a more structured resident ranking process and that subsequent adjustments to the rank list generated by this process should be undertaken with caution. Copyright © 2012 Association of Program Directors in Surgery

  9. Personal Therapy in Psychiatry Residency Training: A National Survey of Canadian Psychiatry Residents.

    Science.gov (United States)

    Hadjipavlou, George; Halli, Priyanka; Hernandez, Carlos A Sierra; Ogrodniczuk, John S

    2016-02-01

    The authors collected nationally representative data on Canadian residents' experiences with and perspectives on personal psychotherapy in their psychiatric training. A 43-item questionnaire was distributed electronically to all current psychiatry residents in Canada (N = 839). Four hundred residents from every program across Canada returned the survey (response rate 47.7%). The prevalence of personal therapy at any time was 55.3%, with 42.8% receiving personal therapy during residency. Of residents who undertook personal psychotherapy, 59.3% engaged in weekly therapy, 74.1% received psychodynamic psychotherapy, and 81.5% participated in long-term therapy (>1 year). Personal growth, self-understanding, and professional development were the most common reasons for engaging in personal therapy; however, one-third of residents did so to alleviate symptoms of depression, anxiety, or other mental health concerns. Time was the most important factor impeding residents from personal therapy; only 8.8% found stigma to act as a barrier. The vast majority of residents rated their experience with personal therapy as having a positive or very positive impact on their personal life (84.8%) and overall development as psychiatrists (81.8%). For 64% of respondents, personal therapy had an important or very important role in psychiatry residency training. Residents who received personal therapy rated themselves as better able to understand what happens moment by moment during therapy sessions, detect and deal with patients' emotional reactions, and constructively use their personal reactions to patients. Interest in personal therapy remains strong among psychiatry trainees in Canada. Residents who engaged in psychotherapy endorsed greater confidence in psychotherapy and rated their psychotherapy skills more favorably than those who had never been in the patient role, supporting the view of personal therapy as an important adjunct to psychotherapy training during residency.

  10. Numerical simulation of onshore separation processes - residence time optimization

    Energy Technology Data Exchange (ETDEWEB)

    Fonte, Clarissa Bergman; Oliveira Junior, Joao Americo Aguirre [Engineering Simulation and Scientific Software (ESSS), Florianopolis, SC (Brazil)], E-mails: clarissa@esss.com.br, joao.aguirre@esss.com.br; Dutra, Eduardo Stein Soares [PETROBRAS E e P Engenharia de Producao, Rio de Janeiro, RJ (Brazil). Gerencia de Engenharia de Instalacoes de Superficie e Automacao], E-mail: eduardodutra@petrobras.com.br

    2011-04-15

    Cylindrical tanks are commonly used in onshore facilities to process and treat oil and water streams. These tanks generate a gravitational separation and, when sedimentation velocity is reached, the residence time inside the tank is crucial to guarantee proper separation. The ideal geometry for a tank maximizes the effective residence time by providing the largest possible fluid path, along which sedimentation of the denser phase occurs. Large volume tanks can be used for this purpose. However, internal devices, which increase the effective residence time and decrease undesirable hydrodynamic effects, are a commonly used alternative, allowing a reduction in tank size. This study focuses on the application of computational fluid dynamics as a tool to analyze four geometries found in gravitational separation tanks to identify that which offers the highest residence time values. (author)

  11. Simulation-based education with mastery learning improves residents' lumbar puncture skills

    Science.gov (United States)

    Cohen, Elaine R.; Caprio, Timothy; McGaghie, William C.; Simuni, Tanya; Wayne, Diane B.

    2012-01-01

    Objective: To evaluate the effect of simulation-based mastery learning (SBML) on internal medicine residents' lumbar puncture (LP) skills, assess neurology residents' acquired LP skills from traditional clinical education, and compare the results of SBML to traditional clinical education. Methods: This study was a pretest-posttest design with a comparison group. Fifty-eight postgraduate year (PGY) 1 internal medicine residents received an SBML intervention in LP. Residents completed a baseline skill assessment (pretest) using a 21-item LP checklist. After a 3-hour session featuring deliberate practice and feedback, residents completed a posttest and were expected to meet or exceed a minimum passing score (MPS) set by an expert panel. Simulator-trained residents' pretest and posttest scores were compared to assess the impact of the intervention. Thirty-six PGY2, 3, and 4 neurology residents from 3 medical centers completed the same simulated LP assessment without SBML. SBML posttest scores were compared to neurology residents' baseline scores. Results: PGY1 internal medicine residents improved from a mean of 46.3% to 95.7% after SBML (p < 0.001) and all met the MPS at final posttest. The performance of traditionally trained neurology residents was significantly lower than simulator-trained residents (mean 65.4%, p < 0.001) and only 6% met the MPS. Conclusions: Residents who completed SBML showed significant improvement in LP procedural skills. Few neurology residents were competent to perform a simulated LP despite clinical experience with the procedure. PMID:22675080

  12. Elective time during dermatology residency: A survey of residents and program directors.

    Science.gov (United States)

    Uppal, Pushpinder; Shantharam, Rohini; Kaufmann, Tara Lynn

    2017-12-15

    Elective time during residency training provides residents with exposure to different subspecialties. This opportunity gives residents the chance tonurture growth in particular areas of interest and broaden their knowledge base in certain topics in dermatology by having the chance to work withexperts in the field. The purpose of this study was to assess the views of residency program directors and dermatology residents on the value of elective time through a cross sectional survey. An eight-questionIRB exempt survey was sent out to 113 residency program directors via email through the American Professors of Dermatology (APD) program director listserv. Program directors were asked to forward a separate set of 9 questions to their residents. The majority of programs that responded allowed for some elective time within their schedule, often duringthe PGY 4 (3rd year of dermatology training), but the amount of time allowed widely varied among many residency programs. Overall, residents and program directors agree that elective is important in residencytraining, but no standardization is established across programs.

  13. Operative time and cost of resident surgical experience: effect of instituting an otolaryngology residency program.

    Science.gov (United States)

    Pollei, Taylor R; Barrs, David M; Hinni, Michael L; Bansberg, Stephen F; Walter, Logan C

    2013-06-01

    Describe the procedure length difference between surgeries performed by an attending surgeon alone compared with the resident surgeon supervised by the same attending surgeon. Case series with chart review. Tertiary care center and residency program. Six common otolaryngologic procedures performed between August 1994 and May 2012 were divided into 2 cohorts: attending surgeon alone or resident surgeon. This division coincided with our July 2006 initiation of an otolaryngology-head and neck surgery residency program. Operative duration was compared between cohorts with confounding factors controlled. In addition, the direct result of increased surgical length on operating room cost was calculated and applied to departmental and published resident case log report data. Five of the 6 procedures evaluated showed a statistically significant increase in surgery length with resident involvement. Operative time increased 6.8 minutes for a cricopharyngeal myotomy (P = .0097), 11.3 minutes for a tonsillectomy (P operative time difference. Cost of increased surgical time was calculated per surgery and ranged from $286 (cricopharyngeal myotomy) to $2142 (mastoidectomy). When applied to reported national case log averages for graduating residents, this resulted in a significant increase of direct training-related costs. Resident participation in the operating room results in increased surgical length and additional system cost. Although residency is a necessary part of surgical training, associated costs need to be acknowledged.

  14. Ambulatory-based education in internal medicine: current organization and implications for transformation. Results of a national survey of resident continuity clinic directors.

    Science.gov (United States)

    Nadkarni, Mohan; Reddy, Siddharta; Bates, Carol K; Fosburgh, Blair; Babbott, Stewart; Holmboe, Eric

    2011-01-01

    Many have called for ambulatory training redesign in internal medicine (IM) residencies to increase primary care career outcomes. Many believe dysfunctional, clinic environments are a key barrier to meaningful ambulatory education, but little is actually known about the educational milieu of continuity clinics nationwide. We wished to describe the infrastructure and educational milieu at resident continuity clinics and assess clinic readiness to meet new IM-RRC requirements. National survey of ACGME accredited IM training programs. Directors of academic and community-based continuity clinics. Two hundred and twenty-one out of 365 (62%) of clinic directors representing 49% of training programs responded. Wide variation amongst continuity clinics in size, structure and educational organization exist. Clinics below the 25th percentile of total clinic sessions would not meet RRC-IM requirements for total number of clinic sessions. Only two thirds of clinics provided a longitudinal mentor. Forty-three percent of directors reported their trainees felt stressed in the clinic environment and 25% of clinic directors felt overwhelmed. The survey used self reported data and was not anonymous. A slight predominance of larger clinics and university based clinics responded. Data may not reflect changes to programs made since 2008. This national survey demonstrates that the continuity clinic experience varies widely across IM programs, with many sites not yet meeting new ACGME requirements. The combination of disadvantaged and ill patients with inadequately resourced clinics, stressed residents, and clinic directors suggests that many sites need substantial reorganization and institutional commitment.New paradigms, encouraged by ACGME requirement changes such as increased separation of inpatient and outpatient duties are needed to improve the continuity clinic experience.

  15. The Spillover of US Immigration Policy on Citizens and Permanent Residents of Mexican Descent: How Internalizing ‘Illegality’ Impacts Public Health in the Borderlands

    Directory of Open Access Journals (Sweden)

    Samantha eSabo

    2015-06-01

    Full Text Available Background: The militarization of the U.S.-Mexico border region exacerbates the process of ‘Othering’ Latino immigrants—as illegal aliens. The internalization of ‘illegality’ can manifest as a sense of undeservingness of legal protection in the population and be detrimental on a biopsychological level. Objective: We explore the impacts of ‘illegality’ among a population of US citizen and permanent resident farmworkers of Mexican descent. We do so through the lens of immigration enforcement-related stress and the ability to file formal complaints of discrimination and mistreatment perpetrated by local immigration enforcement agents, including local police authorized to enforce immigration law. Methods: Drawing from cross-sectional data gathered through the National Institute of Occupation Safety and Health, Challenges to Farmworker Health at the US-Mexico Border study, a community-based participatory research project conducted at the Arizona-Sonora border, we compared Arizona resident farmworkers (N=349 to Mexico-based farmworkers (N=140 or Transnational farmworkers who cross the US-Mexico border daily or weekly to work in US agriculture. Results: Both samples of farmworkers experience significant levels of stress in anticipation of encounters with immigration officials. Fear was cited as the greatest factor preventing individuals from reporting immigration abuses. The groups varied slightly in the relative weight attributed to different types of fear. Conclusion: The militarization of the border has consequences for individuals who are not the target of immigration enforcement. These spillover effects cause harm to farmworkers in multiple ways. Multi institutional and community-centered systems for reporting immigration related victimization is required. Applied participatory research with affected communities can mitigate the public health effects of state-sponsored immigration discrimination and violence among US citizen and

  16. Workplace bullying of general surgery residents by nurses.

    Science.gov (United States)

    Schlitzkus, Lisa L; Vogt, Kelly N; Sullivan, Maura E; Schenarts, Kimberly D

    2014-01-01

    Workplace bullying is at the forefront of social behavior research, garnering significant media attention. Most of the medical research has addressed bullying of nurses by physicians and demonstrates that patient care and outcomes may suffer. The intent of this study was to determine if general surgery residents are bullied by nurses. A survey instrument previously validated (Negative Acts Questionnaire-Revised) to evaluate for workplace bullying was modified to reflect the resident-nurse relationship. After institutional review board approval, the piloted online survey was sent to general surgery program directors to forward to general surgery residents. Demographic data are presented as percentages, and for negative acts, percentages of daily, weekly, and monthly frequencies are combined. Allopathic general surgery residencies in the United States. General surgery residents. The response rate was 22.1% (n = 452). Most respondents were men (55%) and had a mean age of 29 years (standard deviation = 7). Although 27.0% of the respondents were interns, the remaining classes were equally represented (12%-18% of responses/class). The respondents were primarily from medium-sized residency programs (45%), in the Midwest (28%), training in university programs (72%), and rotating primarily in a combined private and county hospital that serves both insured and indigent patients (59%). The residents had experienced each of the 22 negative acts (11.5%-82.5%). Work-related bullying occurs more than person-related bullying and physical intimidation. Ignoring of recommendations or orders by nurses occurs on a daily, weekly, or monthly basis for 30.2% of residents (work-related bullying). The most frequent person-related bullying act is ignoring the resident when they approach or reacting in a hostile manner (18.0%), followed by ignoring or excluding the resident (17.1%). Workplace bullying of general surgery residents by nurses is prominent. Future research is needed to determine

  17. Neuroscience and humanistic psychiatry: a residency curriculum.

    Science.gov (United States)

    Griffith, James L

    2014-04-01

    Psychiatry residencies with a commitment to humanism commonly prioritize training in psychotherapy, cultural psychiatry, mental health policy, promotion of human rights, and similar areas reliant upon dialogue and collaborative therapeutic relationships. The advent of neuroscience as a defining paradigm for psychiatry has challenged residencies with a humanistic focus due to common perceptions that it would entail constriction of psychiatric practice to diagnostic and psychopharmacology roles. The author describes a neuroscience curriculum that has taught psychopharmacology effectively, while also advancing effectiveness of language-based and relationship-based therapeutics. In 2000, the George Washington University psychiatry residency initiated a neuroscience curriculum consisting of (1) a foundational postgraduate year 2 seminar teaching cognitive and social neuroscience and its integration into clinical psychopharmacology, (2) advanced seminars that utilized a neuroscience perspective in teaching specific psychotherapeutic skill sets, and (3) case-based teaching in outpatient clinical supervisions that incorporated a neuroscience perspective into traditional psychotherapy supervisions. Curricular assessment was conducted by (1) RRC reaccreditation site visit feedback, (2) examining career trajectories of residency graduates, (3) comparing PRITE exam Somatic Treatments subscale scores for 2010-2012 residents with pre-implementation residents, and (4) postresidency survey assessment by 2010-2012 graduates. The 2011 RRC site visit report recommended a "notable practice" citation for "innovative neurosciences curriculum." Three of twenty 2010-2012 graduates entered neuroscience research fellowships, as compared to none before the new curriculum. PRITE Somatic Treatments subscale scores improved from the 23rd percentile to the 62nd percentile in pre- to post-implementation of curriculum (p neuroscience curriculum for a residency committed to humanistic psychiatry

  18. Resident away rotations allow adaptive neurosurgical training.

    Science.gov (United States)

    Gephart, Melanie Hayden; Derstine, Pamela; Oyesiku, Nelson M; Grady, M Sean; Burchiel, Kim; Batjer, H Hunt; Popp, A John; Barbaro, Nicholas M

    2015-04-01

    Subspecialization of physicians and regional centers concentrate the volume of certain rare cases into fewer hospitals. Consequently, the primary institution of a neurological surgery training program may not have sufficient case volume to meet the current Residency Review Committee case minimum requirements in some areas. To ensure the competency of graduating residents through a comprehensive neurosurgical education, programs may need for residents to travel to outside institutions for exposure to cases that are either less common or more regionally focused. We sought to evaluate off-site rotations to better understand the changing demographics and needs of resident education. This would also allow prospective monitoring of modifications to the neurosurgery training landscape. We completed a survey of neurosurgery program directors and query of data from the Accreditation Council of Graduate Medical Education to characterize the current use of away rotations in neurosurgical education of residents. We found that 20% of programs have mandatory away rotations, most commonly for exposure to pediatric, functional, peripheral nerve, or trauma cases. Most of these rotations are done during postgraduate year 3 to 6, lasting 1 to 15 months. Twenty-six programs have 2 to 3 participating sites and 41 have 4 to 6 sites distinct from the host program. Programs frequently offset potential financial harm to residents rotating at a distant site by support of housing and transportation costs. As medical systems experience fluctuating treatment paradigms and demographics, over time, more residency programs may adapt to meet the Accreditation Council of Graduate Medical Education case minimum requirements through the implementation of away rotations.

  19. Assessing experiential education factors contributing to a PGY1 residency match: Pharmacy residency program director and comparative student survey.

    Science.gov (United States)

    Prisco, Jennifer L; Hritcko, Philip M; Feret, Brett; Yorra, Mark L; Todd, Noreen E; Kim Tanzer; Basile, Cathy; Bonaceto, Kara; Morelli, Rita; Carace, Nicole; Szumita, Andrew

    2018-02-01

    To compare and contrast experiential education perceptions of pharmacy residency program directors (RPDs) and doctor of pharmacy students in their last year of the curriculum for residency application considerations. The New England Regional Departments of Experiential Education (NERDEE) consortium developed a 17-question survey to assess residency factors, including those related to experiential education. The survey was dispersed to advanced pharmacy practice experience (APPE) students from six colleges/schools of pharmacy and RPDs nationwide. Students have different values on experiential preferences compared to RPDs. Sample findings include internal medicine and specialty clinical elective experiences prior to American Society of Health-System Pharmacists (ASHP) Midyear were extremely important to important for students, while RPDs viewed these experiences as somewhat important at best (p hinder a successful postgraduate year 1 (PGY1) residency match. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    1997-06-01

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

  1. 26 CFR 1.871-4 - Proof of residence of aliens.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 9 2010-04-01 2010-04-01 false Proof of residence of aliens. 1.871-4 Section 1... (CONTINUED) INCOME TAXES Nonresident Aliens and Foreign Corporations § 1.871-4 Proof of residence of aliens... alien within the United States has acquired residence therein for purposes of the income tax. (b...

  2. Protected Time for Research During Orthopaedic Residency Correlates with an Increased Number of Resident Publications.

    Science.gov (United States)

    Williams, Benjamin R; Agel, Julie A; Van Heest, Ann E

    2017-07-05

    The Accreditation Council for Graduate Medical Education (ACGME) requires orthopaedic residency programs to promote scholarship and research, which manifest differently among programs. We assess the impact of protected research time during orthopaedic residency on the number of resident publications. Rotation schedules and resident names were collected from 125 ACGME-accredited U.S. orthopaedic residency programs. Protected research time was classified as 1 of 3 types: (1) block time, (2) longitudinal time, or (3) no dedicated time. In April 2016, we searched residents in postgraduate year (PGY)-3 to PGY-5 on pubmed.gov to generate all orthopaedic publications with a PubMed identifier published during residency. Each publication's 2015 Thomson Reuters Journal Citation Reports 5-Year Journal Impact Factor and resident first authorship were noted. The number of PubMed identifiers for each program was summed and was divided by the number of residents in PGY-3 to PGY-5, giving a mean number of publications per resident. The relationship between output and program research time was compared using t tests and analysis of variance (ANOVA). A total of 1,690 residents were included, with an overall mean number (and standard deviation) of 1.2 ± 2.4 publications per resident. Eighty-seven programs reported block time, 14 programs reported longitudinal time, and 24 programs reported no time. There was a significant difference (p = 0.02) in the mean number of publications per resident when compared between programs with protected time (1.1 ± 1.2 publications) and programs with no protected time (0.6 ± 0.5 publication). One-way ANOVA demonstrated a significant mean difference across the 3 groups (p publications than block time at 1.0 ± 1.0 publication or no time at 0.6 ± 0.5 publication, a difference that persisted when adjusted to include only impact factors of >0 and exclude case reports (p = 0.0015). Both the presence of and the type of dedicated research time correlate

  3. Teacher in Residence: Bringing Science to Students

    CERN Multimedia

    Daisy Yuhas

    CERN welcomes its first Teacher in Residence, Terrence Baine of the University of Oslo. Baine, who originally hails from Canada, will be concurrently completing his PhD in Physics Education during his time at CERN. Like CERN’s High School Teacher Programme (HST), of which Baine is an alumnus, the Teacher in Residence position is designed to help educators spread the science of CERN in a form that is accessible to students and can encourage them to pursue physics throughout their education.   Terrence Baine, first 'teacher in residence' at CERN Baine explains, “It’s very important to have a teacher present who can be that middle person between the young peoplecoming here, whom we are trying to enlighten, and the physicists who work at CERN. The Teacher in Residence can act as an on-site educational consultant.” As Teacher in Residence, Baine’s primary project will be to develop teaching modules, or a series of lesson plans, that can help high schoo...

  4. Satisfaction and gender issues in otolaryngology residency.

    Science.gov (United States)

    Wynn, Rhoda; Rosenfeld, Richard M; Lucente, Frank E

    2005-06-01

    To evaluate the otolaryngology residency experience with attention to operative experience, career guidance, and gender. Otolaryngology residents were anonymously surveyed by mail about their residency experience. The 22-item survey was scored on a 5-point ordinal Likert scale. Responses were analyzed with respect to gender and postgraduate year (PGY) level. Complete surveys were returned by 261 otolaryngology residents (24% female). PGY level correlated with confidence that surgical skills were appropriate (P = 0.003), establishment of solid career network (P = 0.003), and confidence that surgical abilities are adequate for practice (P = 0.028). Female residents reported less confidence that surgical skills were appropriate (P = 0.050) and that surgical abilities were adequate for postresidency practice (P = 0.035). Women were encouraged to enter private practice more often (P = 0.012), were less likely to have a solid career network ( P = 0.025), and were less confident about being able to run their own practice (P = 0.036) Significant differences exist for several questions regarding surgical confidence and career issues, even after correction for PGY level.

  5. Stress and burnout among Swiss dental residents.

    Science.gov (United States)

    Divaris, Kimon; Lai, Caroline S; Polychronopoulou, Argy; Eliades, Theodore; Katsaros, Christos

    2012-01-01

    Stress and burnout have been well-documented in graduate medical and undergraduate dental education, but studies among dental graduate students and residents are sparse. The purpose of this investigation was to examine perceived stressors and three dimensions of burnout among dental residents enrolled in the University of Bern, Switzerland. Thirty-six residents enrolled in five specialty programmes were administered the Graduate Dental Environment Stress (GDES30) questionnaire and the Maslach Burnout Inventory (MBI). Individual stress items and overall GDES30 scores were used to quantify perceived stress. To measure burnout, proportions of burnout "cases" and MBI subscale scores were computed in the domains of emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA). Analyses relied on descriptive and bi-variate methods. The mean GDES30 score was 2.1 (SD = 0.4). "Lack of leisure time", "meeting the research requirement of the programme" and "completing graduation requirements" emerged as the top three stressors. Thirty-six percent of respondents were burnout "cases" on the PA scale, while this proportion was 17% for EE and 8% for DP. Both stress and burnout levels increased according to year of study, whereas younger residents and females had consistently higher stress and burnout scores compared to older ones and males. Overall, low levels of perceived stress and burnout were found among this group of Swiss dental residents.

  6. Measuring Error Identification and Recovery Skills in Surgical Residents.

    Science.gov (United States)

    Sternbach, Joel M; Wang, Kevin; El Khoury, Rym; Teitelbaum, Ezra N; Meyerson, Shari L

    2017-02-01

    Although error identification and recovery skills are essential for the safe practice of surgery, they have not traditionally been taught or evaluated in residency training. This study validates a method for assessing error identification and recovery skills in surgical residents using a thoracoscopic lobectomy simulator. We developed a 5-station, simulator-based examination containing the most commonly encountered cognitive and technical errors occurring during division of the superior pulmonary vein for left upper lobectomy. Successful completion of each station requires identification and correction of these errors. Examinations were video recorded and scored in a blinded fashion using an examination-specific rating instrument evaluating task performance as well as error identification and recovery skills. Evidence of validity was collected in the categories of content, response process, internal structure, and relationship to other variables. Fifteen general surgical residents (9 interns and 6 third-year residents) completed the examination. Interrater reliability was high, with an intraclass correlation coefficient of 0.78 between 4 trained raters. Station scores ranged from 64% to 84% correct. All stations adequately discriminated between high- and low-performing residents, with discrimination ranging from 0.35 to 0.65. The overall examination score was significantly higher for intermediate residents than for interns (mean, 74 versus 64 of 90 possible; p = 0.03). The described simulator-based examination with embedded errors and its accompanying assessment tool can be used to measure error identification and recovery skills in surgical residents. This examination provides a valid method for comparing teaching strategies designed to improve error recognition and recovery to enhance patient safety. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Patient satisfaction and resident postgraduate year status.

    Science.gov (United States)

    Nadkarni, Girish N; Sabharwal, Manpreet Singh; Ammakkanavar, Natraj Reddy; Annapureddy, Narender; Malhan, Rishi; Mehta, Bijal; Kanakadandi, Vijay Naag; Agarwal, Shiv Kumar; Fried, Ethan D

    2014-01-01

    Patient satisfaction has been recognized as an important variable affecting healthcare behavior. However, there are limited data on the relationship between doctor post-graduate year (PGY) status and patient satisfaction with provider interpersonal skills and humanistic qualities. The authors aims to assess this relationship using an American Board of Internal Medicine (ABIM) questionnaire. Participants were: patients attending a primary care clinic at a large urban academic hospital; and physicians treating them. The survey questionnaire was the ABIM patient satisfaction instrument; ten questions pertaining to humanistic qualities and communication skills with responses from poor to excellent. Mann Whitney U test and multi-variable logistic regression analyses were used to explore score differences by PGY level. The postgraduate year one (PGY1) had higher patient-satisfaction levels compared to PGY2/PGY3 residents. The PGY1 level residents were more likely to score in the 90th percentile and this remained constant even after adjusting for confounders. The research was a single-center study and may have been subject to confounding factors such as patient personality types and a survey ceiling effect. The survey's cross-sectional nature may also be a potential limitation. Practical implications - Patient satisfaction varies significantly with PGY status. Though clinical skills may improve with increasing experience, findings imply that interpersonal and humanistic qualities may deteriorate. The study is the first to assess patient satisfaction with PGY status and provides evidence that advanced trainees may need support to keep their communication skills and humanistic qualities from deteriorating as stressors increase to ensure optimal patient satisfaction.

  8. Comparing IM Residents with EM Resident for Their Skills of ECG Interpretation and Outlining Management Plan Accordingly

    Directory of Open Access Journals (Sweden)

    Hamid Reza Karimpoor Tari

    2009-06-01

    Full Text Available Background and Purpose: Electrocardiogram (ECG is one of the most commonly performed investigations in cardiac diseases and ECG abnormalities can reveal the early manifestations of cardiac ischemia, metabolic disorders, or life-threatening disrhythmias. Misinterpretation of ECG and its consequent mistreatment or performing inessential  interventions may cause life-threatening cardiac events. Since EM residents and internal medicine (IM residents are usually the first to visit at bedside and start treatments based on patient’s ECG, we intended to evaluate the ability of EM residents to interpret ECGs and to compare it with that of IM residents using various ECG samples.Method: 63 participants including 33 IM residents and 30 EM residents from two education hospitals of Shahid Beheshti University of Medical Sciences were enrolled in our study. A diagnosis test consisting of 15 ECG samples associated with a questionnaire containing questions about gender, academic year and proficiency in ECG interpretation was taken from all participants. This study was conducted under the supervision of a cardiologist and an emergency specialist who supervised the ECG selection, answers and scoring of each ECG. The maximum score for each ECG was 6 which were given to a completely correct diagnosis and -0.25 negative point was given if the answer was wrong or any differential diagnosis was mentioned. After the test, the answer sheets were collected and wereanalyzed with SPSS program, by two of study authors who were kept blind to the real identities of participants.Results: After classification of groups, the overall mean score was 45.5/100 (38-60. The mean score of IM and EM residents was 56.0/100 (44.9-72 and 38.9/100 (31.5-45.5, respectively (p< 0.001.No significant correlation was found between the diagnosis scores and participant’s self-judgment on her/his ECG interpretation skills (p=0.897, r=0.017. Five ECGs were considered as the most important and

  9. Factors influencing resident's decision to reside in gated and guarded community

    Science.gov (United States)

    Shamsudin, Zarina; Shamsudin, Shafiza; Zainal, Rozlin

    2017-10-01

    Gated communities are residential areas developed with restricted access with strictly controlled entrances and surrounded by a close perimeter of wall or fences. Developers, conscious of the need to fulfill the requirement of living in modern and sophisticated lifestyle and gated properties become the trend and mushroomed over the past decade. Nowadays, it is obvious that gated and guarded communities become almost a dominant feature of Malaysia housing development projects. The focus of this paper is to identify the factors contribute resident's decision to reside in gated and guarded community and to study social interaction among gated communities' residents. 150 questionnaires were distributed to the residents of selected gated and guarded community area in order to achieve the objectives and analyzed by using Statistical Package for Social Science (SPSS) and descriptive analysis. The result was tabulated and presented in charts and graphs for a clear and better understanding. The five main factors contribute to resident decision to reside in gated communities were identified and ranked; there are privacy, security, location, lifestyle and prestige. Besides, the residents are feeling neutral towards the facilities and services provided in their gated and guarded residential area. A comprehensive improvement towards the facilities and services is needed to reach higher satisfaction from the residents.

  10. Career Interests of Canadian Psychiatry Residents: What Makes Residents Choose a Research Career?

    Science.gov (United States)

    Laliberté, Vincent; Rapoport, Mark J.; Andrew, Melissa; Davidson, Marla

    2016-01-01

    Objectives: Training future clinician-researchers remains a challenge faced by Canadian psychiatry departments. Our objectives were to determine the prevalence of residents interested in pursuing research and other career options as part of their practice, and to identify the factors associated with interest in research. Method: Data from a national online survey of 207 Canadian psychiatry residents from a total of 853 (24.3% response rate) were examined. The main outcome was interest in research as part of residents’ future psychiatrist practice. Bivariate and multivariate analyses were performed to identify demographic and vocational variables associated with research interest. Results: Interest in research decreases by 76% between the first and fifth year of psychiatry residency (OR 0.76 per year, 95% CI 0.60 to 0.97). Training in a department with a residency research track did not correlate with increased research interest (χ2 = 0.007, df = 1, P = 0.93). Conclusions: Exposing and engaging psychiatry residents in research as early as possible in residency training appears key to promoting future research interest. Psychiatry residency programs and research tracks could consider emphasizing research training initiatives and protected research time early in residency. PMID:27253699

  11. Publication misrepresentation among anesthesiology residency applicants.

    Science.gov (United States)

    Neuman, Stephanie A; Long, Timothy R; Rose, Steven H

    2011-03-01

    Publication misrepresentation has been documented among applicants for residency positions in several specialties. However, these data are not available for anesthesiology applicants. Our purpose in this study was to document the prevalence of publication misrepresentation among applicants to a single anesthesiology residency, to compare anesthesiology publication misrepresentation data with similar data in other specialties, and to determine how often publication misrepresentation leads to an unfair competitive advantage in the application process. Applications to the Mayo School of Graduate Medical Education anesthesiology core residency in Rochester, Minnesota, were reviewed for publication misrepresentations using Medline and PubMed databases, Mayo Clinic library databases, and/or review by a qualified medical librarian. Misrepresented publications underwent further review to identify fraudulent publications and/or citation errors that provide an unfair competitive advantage. The authors found that 2.4% of the applications (13 of 532) included fraudulent publications, 6.6% of the applications with at least 1 publication (13 of 197) included ≥1 that was fraudulent, and 2.9% of all cited publications (15 of 522) were fraudulent. In addition, 0.9% of the applications (5 of 532) contained a citation error that, although not grossly fraudulent, could have favorably affected the applicant's competitiveness for a residency position. Misrepresented publications were fairly common among anesthesiology residency applicants. However, only a small percentage of applicants listed misrepresented publications that were clearly fraudulent or contained a citation error that conferred a competitive advantage. Identification of fraudulent publications on Electronic Residency Application Service applications is important to maintain the integrity of the application process.

  12. Pediatric Oncology Branch - training- resident electives | Center for Cancer Research

    Science.gov (United States)

    Resident Electives Select pediatric residents may be approved for a 4-week elective rotation at the Pediatric Oncology Branch. This rotation emphasizes the important connection between research and patient care in pediatric oncology. The resident is supervised directly by the Branch’s attending physician and clinical fellows. Residents attend daily in-patient and out-patient

  13. 22 CFR 42.22 - Returning resident aliens.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Returning resident aliens. 42.22 Section 42.22... Returning resident aliens. (a) Requirements for returning resident status. An alien shall be classifiable as... presented that: (1) The alien had the status of an alien lawfully admitted for permanent residence at the...

  14. 31 CFR 515.335 - Permanent resident alien.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Permanent resident alien. 515.335... Definitions § 515.335 Permanent resident alien. As used in § 515.208, the term permanent resident alien means an alien lawfully admitted for permanent residence into the United States. [61 FR 37386, July 18...

  15. 24 CFR 964.120 - Resident management corporation requirements.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Resident management corporation... § 964.120 Resident management corporation requirements. A resident management corporation must consist... resident council, so long as each such council: (1) Approves the establishment of the corporation; and (2...

  16. An Evidence-based, Longitudinal Curriculum for Resident Physician Wellness: The 2017 Resident Wellness Consensus Summit.

    Science.gov (United States)

    Arnold, Jacob; Tango, Jennifer; Walker, Ian; Waranch, Chris; McKamie, Joshua; Poonja, Zafrina; Messman, Anne

    2018-03-01

    Physicians are at much higher risk for burnout, depression, and suicide than their non-medical peers. One of the working groups from the May 2017 Resident Wellness Consensus Summit (RWCS) addressed this issue through the development of a longitudinal residency curriculum to address resident wellness and burnout. A 30-person (27 residents, three attending physicians) Wellness Curriculum Development workgroup developed the curriculum in two phases. In the first phase, the workgroup worked asynchronously in the Wellness Think Tank - an online resident community - conducting a literature review to identify 10 core topics. In the second phase, the workgroup expanded to include residents outside the Wellness Think Tank at the live RWCS event to identify gaps in the curriculum. This resulted in an additional seven core topics. Seventeen foundational topics served as the framework for the longitudinal resident wellness curriculum. The curriculum includes a two-module introduction to wellness; a seven-module "Self-Care Series" focusing on the appropriate structure of wellness activities and everyday necessities that promote physician wellness; a two-module section on physician suicide and self-help; a four-module "Clinical Care Series" focusing on delivering bad news, navigating difficult patient encounters, dealing with difficult consultants and staff members, and debriefing traumatic events in the emergency department; wellness in the workplace; and dealing with medical errors and shame. The resident wellness curriculum, derived from an evidence-based approach and input of residents from the Wellness Think Tank and the RWCS event, provides a guiding framework for residency programs in emergency medicine and potentially other specialties to improve physician wellness and promote a culture of wellness.

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

    Science.gov (United States)

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

    2017-10-01

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

  18. An Evidence-based, Longitudinal Curriculum for Resident Physician Wellness: The 2017 Resident Wellness Consensus Summit

    Directory of Open Access Journals (Sweden)

    Jacob Arnold

    2018-02-01

    Full Text Available Introduction: Physicians are at much higher risk for burnout, depression, and suicide than their non-medical peers. One of the working groups from the May 2017 Resident Wellness Consensus Summit (RWCS addressed this issue through the development of a longitudinal residency curriculum to address resident wellness and burnout. Methods: A 30-person (27 residents, three attending physicians Wellness Curriculum Development workgroup developed the curriculum in two phases. In the first phase, the workgroup worked asynchronously in the Wellness Think Tank – an online resident community – conducting a literature review to identify 10 core topics. In the second phase, the workgroup expanded to include residents outside the Wellness Think Tank at the live RWCS event to identify gaps in the curriculum. This resulted in an additional seven core topics. Results: Seventeen foundational topics served as the framework for the longitudinal resident wellness curriculum. The curriculum includes a two-module introduction to wellness; a seven-module “Self-Care Series” focusing on the appropriate structure of wellness activities and everyday necessities that promote physician wellness; a two-module section on physician suicide and self-help; a four-module “Clinical Care Series” focusing on delivering bad news, navigating difficult patient encounters, dealing with difficult consultants and staff members, and debriefing traumatic events in the emergency department; wellness in the workplace; and dealing with medical errors and shame. Conclusion: The resident wellness curriculum, derived from an evidence-based approach and input of residents from the Wellness Think Tank and the RWCS event, provides a guiding framework for residency programs in emergency medicine and potentially other specialties to improve physician wellness and promote a culture of wellness.

  19. Ontario Radiation Oncology Residents' Needs in the First Postgraduate Year-Residents' Perspective Survey

    International Nuclear Information System (INIS)

    Szumacher, Ewa; Warner, Eiran; Zhang Liying; Kane, Gabrielle; Ackerman, Ida; Nyhof-Young, Joyce; Agboola, Olusegun; Metz, Catherine de; Rodrigues, George; Voruganti, Sachi; Rappolt, Susan

    2007-01-01

    Purpose: To assess radiation oncology residents' needs and satisfaction in their first postgraduate year (PGY-1) in the province of Ontario. Methods and Materials: Of 62 radiation oncology residents, 58 who had completed their PGY-1 and were either enrolled or had graduated in 2006 were invited to participate in a 31-item survey. The questionnaire explored PGY-1 residents' needs and satisfaction in four domains: clinical workload, faculty/learning environment, stress level, and discrimination/harassment. The Fisher's exact and Wilcoxon nonparametric tests were used to determine relationships between covariate items and summary scores. Results: Of 58 eligible residents, 44 (75%) responded. Eighty-four percent of residents felt that their ward and call duties were appropriate. More than 50% of respondents indicated that they often felt isolated from their radiation oncology program. Only 77% agreed that they received adequate feedback, and 40% received sufficient counseling regarding career planning. More than 93% of respondents thought that faculty members had contributed significantly to their learning experience. Approximately 50% of residents experienced excessive stress and inadequate time for leisure or for reading the medical literature. Less than 10% of residents indicated that they had been harassed or experienced discrimination. Eighty-three percent agreed or strongly agreed that their PGY-1 experience had been outstanding. Conclusions: Most Ontario residents were satisfied with their PGY-1 training program. More counseling by radiation oncology faculty members should be offered to help residents with career planning. The residents might also benefit from more exposure to 'radiation oncology' and an introduction to stress management strategies

  20. Deprivation of Dignity in Nursing Home Residents

    DEFF Research Database (Denmark)

    Høy, Bente

    2016-01-01

    deepened knowledge in how to maintain and promote dignity in nursing home residents. The purpose of this paper is to present results concerning the question: How is nursing home residents’ dignity maintained or deprived from the perspective of close family caregivers? In this presentation we only focus...... on deprivation of dignity. Methodology: The overall design of this study is modified clinical application research. The study took place at six different nursing home residences in Sweden, Denmark and Norway. Data collection methods were individual research interviews. All together the sample consisted of 28...

  1. Practice management education during surgical residency.

    Science.gov (United States)

    Jones, Kory; Lebron, Ricardo A; Mangram, Alicia; Dunn, Ernest

    2008-12-01

    Surgical education has undergone radical changes in the past decade. The introductions of laparoscopic surgery and endovascular techniques have required program directors to alter surgical training. The 6 competencies are now in place. One issue that still needs to be addressed is the business aspect of surgical practice. Often residents complete their training with minimal or no knowledge on coding of charges or basic aspects on how to set up a practice. We present our program, which has been in place over the past 2 years and is designed to teach the residents practice management. The program begins with a series of 10 lectures given monthly beginning in August. Topics include an introduction to types of practices available, negotiating a contract, managed care, and marketing the practice. Both medical and surgical residents attend these conferences. In addition, the surgical residents meet monthly with the business office to discuss billing and coding issues. These are didactic sessions combined with in-house chart reviews of surgical coding. The third phase of the practice management plan has the coding team along with the program director attend the outpatient clinic to review in real time the evaluation and management coding of clinic visits. Resident evaluations were completed for each of the practice management lectures. The responses were recorded on a Likert scale. The scores ranged from 4.1 to 4.8 (average, 4.3). Highest scores were given to lectures concerning negotiating employee agreements, recruiting contracts, malpractice insurance, and risk management. The medical education department has tracked resident coding compliance over the past 2 years. Surgical coding compliance increased from 36% to 88% over a 12-month period. The program director who participated in the educational process increased his accuracy from 50% to 90% over the same time period. When residents finish their surgical training they need to be ready to enter the world of business

  2. Discharge residence of TLD tagged fish

    International Nuclear Information System (INIS)

    Romberg, G.P.; Prepejchal, W.

    1974-01-01

    Although visual observations suggested that fish remained in the discharge for considerable periods, temperature-sensitive tags indicated the majority of fish spend less than 50 hr or 10 percent of the time at discharge temperatures. During 1974 a second fish tagging study was conducted, using temperature-sensitive tags to yield discharge residence times of Lake Michigan salmonids at Point Beach thermal discharge. Preliminary results revealed that many fish tag values were close to Unit I line indicating that calculated maximum discharge residence times for these fish will be nearly 100 percent of the elapsed time

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

    Science.gov (United States)

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

    2015-12-01

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

  4. Development and implementation of a residency project advisory board.

    Science.gov (United States)

    Dagam, Julie K; Iglar, Arlene; Kindsfater, Julie; Loeb, Al; Smith, Chad; Spexarth, Frank; Brierton, Dennis; Woller, Thomas

    2017-06-15

    The development and implementation of a residency project advisory board (RPAB) to manage multiple pharmacy residents' yearlong projects across several residency programs are described. Preceptor and resident feedback during our annual residency program review and strategic planning sessions suggested the implementation of a more-coordinated approach to the identification, selection, and oversight of all components of the residency project process. A panel of 7 department leaders actively engaged in residency training and performance improvement was formed to evaluate the residency project process and provide recommendations for change. These 7 individuals would eventually constitute the RPAB. The primary objective of the RPAB at Aurora Health Care is to provide oversight and a structured framework for the selection and execution of multiple residents' yearlong projects across all residency programs within our organization. Key roles of the RPAB include developing expectations, coordinating residency project ideas, and providing oversight and feedback. The development and implementation of the RPAB resulted in a significant overhaul of our entire yearlong resident project process. Trends toward success were realized after the first year of implementation, including consistent expectations, increased clarity and engagement in resident project ideas, and more projects meeting anticipated endpoints. The development and implementation of an RPAB have provided a framework to optimize the organization, progression, and outcomes of multiple pharmacy resident yearlong projects in all residency programs across our pharmacy enterprise. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  5. Is past academic productivity predictive of radiology resident academic productivity?

    Science.gov (United States)

    Patterson, Stephanie K; Fitzgerald, James T; Boyse, Tedric D; Cohan, Richard H

    2002-02-01

    The authors performed this study to determine whether academic productivity in college and medical school is predictive of the number of publications produced during radiology residency. The authors reviewed the records of 73 radiology residents who completed their residency from 1990 to 2000. Academic productivity during college, medical school, and radiology residency, other postgraduate degrees, and past careers other than radiology were tabulated. The personal essay attached to the residency application was reviewed for any stated academic interest. Residents were classified as being either previously productive or previously unproductive. Publication rates during residency and immediately after residency were compared for the two groups. For the productive residents, a correlation analysis was used to examine the relationship between past frequency of publication and type of previous activity. Least-squares regression analysis was used to investigate the relationship between preresidency academic productivity, advanced degrees, stated interest in academics, and other careers and radiology residency publications. There was no statistically significant difference in the number of articles published by those residents who were active and those who were not active before residency (P = .21). Only authorship of papers as an undergraduate was weakly predictive of residency publication. These selected measures of academic productivity as an undergraduate and during medical school are not helpful for predicting publication during residency. There was no difference in publication potential between those residents who were academically productive in the past and those who were not.

  6. Facebook Use between College Resident Advisors' and Their Residents: A Mixed Methods Approach.

    Science.gov (United States)

    Kacvinsky, Lauren E; Moreno, Megan A

    2014-01-01

    Facebook use is nearly ubiquitous among college students. Studies have shown links between Facebook displays of depression or problem drinking and risk of these problems. This project aimed to determine whether Facebook could be used to help Resident Advisors (RAs) identify college students at risk for depression or problem drinking. Interviews were conducted with college freshmen to investigate whether they were Facebook "friends" with their RA. Focus groups were conducted with RAs to determine their views on Facebook friending their dormitory residents and using Facebook to help identify at-risk students. 72 freshmen were interviewed and 25 RAs participated in focus groups; both agreed it is common for RAs and residents to be Facebook friends. RAs commonly noted references to depression and problem drinking on residents' Facebook pages, which often led to in-person discussions with the resident. This study provides support that RAs use Facebook to identify issues that may impact their student residents. RAs emphasized benefits of in-person interactions in order to provide support and obtain additional details about the situation. Universities could consider whether providing RA education about Facebook interactions with residents merits encouragement within their existing RA training programs.

  7. The Relationship Between Academic Motivation and Lifelong Learning During Residency: A Study of Psychiatry Residents.

    Science.gov (United States)

    Sockalingam, Sanjeev; Wiljer, David; Yufe, Shira; Knox, Matthew K; Fefergrad, Mark; Silver, Ivan; Harris, Ilene; Tekian, Ara

    2016-10-01

    To examine the relationship between lifelong learning (LLL) and academic motivation for residents in a psychiatry residency program, trainee factors that influence LLL, and psychiatry residents' LLL practices. Between December 2014 and February 2015, 105 of 173 (61%) eligible psychiatry residents from the Department of Psychiatry, University of Toronto, completed a questionnaire with three study instruments: an LLL needs assessment survey, the Jefferson Scale of Physician Lifelong Learning (JeffSPLL), and the Academic Motivation Scale (AMS). The AMS included a relative autonomy motivation score (AMS-RAM) measuring the overall level of intrinsic motivation (IM). A significant correlation was observed between JeffSPLL and AMS-RAM scores (r = 0.39, P motivation identification domain (mean difference [M] = 0.38; 95% confidence interval [CI] [0.01, 0.75]; P = .045; d = 0.44) compared with senior residents. Clinician scientist stream (CSS) residents had significantly higher JeffSPLL scores compared with non-CSS residents (M = 3.15; 95% CI [0.52, 5.78]; P = .020; d = 0.57). The use of rigorous measures to study LLL and academic motivation confirmed prior research documenting the positive association between IM and LLL. The results suggest that postgraduate curricula aimed at enhancing IM, for example, through support for learning autonomously, could be beneficial to cultivating LLL in learners.

  8. Analysis of PGY-1 Pharmacy Resident Candidate Letters of Recommendation at an Academically Affiliated Residency Program.

    Science.gov (United States)

    McLaughlin, Milena M; Masic, Dalila; Gettig, Jacob P

    2018-04-01

    Letters of recommendation (LORs) are a critical component for differentiating among similarly qualified pharmacy residency candidates. These letters contain information that is difficult to ascertain from curricula vitae and pharmacy school transcripts. LOR writers may use any words or phrases appropriate for each candidate as there is no set framework for LORs. The objective of this study was to characterize descriptive themes in postgraduate year 1 (PGY-1) pharmacy residency candidates' LORs and to examine which themes of PGY-1 pharmacy residency candidates' LORs are predictive of an interview invitation at an academically affiliated residency program. LORs for candidates from the Pharmacy Online Residency Centralized Application System (PhORCAS) from 2013 and 2014 for the Midwestern University PGY-1 Pharmacy Residency were analyzed. LOR characteristics and descriptive themes were collected. All scores for candidate characteristics and overall PhORCAS recommendation were also recorded. A total of 351 LORs for 111 candidates from 2013 (n = 47 candidates) and 2014 (n = 64 candidates) were analyzed; 36 (32.4%) total candidates were offered an interview. Themes that were identified as predictors of an interview included a higher median (interquartile range) number of standout words (3 words [1.3-4] vs 3.8 words [2.5-5.5], P < .01) and teaching references (3.7 words [2.7-6] vs 5.7 words [3.7-7.8], P = .01). For this residency program, standout words and teaching references were important when offering interviews.

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

    Science.gov (United States)

    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.

  10. DETERMINANTS OF SPECIALTY CHOICE OF RESIDENT DOCTORS; CASE STUDY--AMONG RESIDENT DOCTORS IN NIGERIA.

    Science.gov (United States)

    Osuoji, Roland I; Adebanji, Atinuke; Abdulsalam, Moruf A; Oludara, Mobolaji A; Abolarinwa, Abimbola A

    2015-01-01

    This study examined medical specialty selection by Nigerian resident doctors using a marketing research approach to determine the selection criteria and the role of perceptions, expected remuneration, and job placement prospects of various specialties in the selection process. Data were from the Community of residents from April 2014 to July 2014. The cohort included 200 residents, but only 171 had complete information. Data were obtained from a cross section of resident doctors in the Lagos State University Teaching Hospital and at the 2014 Ordinary General Meeting of the National Association of Resident Doctors(NARD) where representatives from over 50 Teaching hospitals in Nigeria attended. Using a client behaviour model as a framework, a tripartite questionnaire was designed and administered to residents to deduce information on their knowledge about and interests in various specialties, their opinions of sixteen specialties, and the criteria they used in specialty selection. A total of 171 (85.5%) questionnaires were returned. ln many instances, consistency between selection criteria and perceptions of a specialty were accompanied by interest in pursuing the specialty. Job security, job availability on completion of programme, duration of training and qualifying examinations were highly correlated with p value marketing research concepts for medical specialty selection (Weissmanet al 2012) stipulates that choice of speciality is influenced by criteria and perception. This study shows that job security expected financial remuneration, and examination requirements for qualification are major determinants of the choice of speciality for residents.

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

    Science.gov (United States)

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

    2018-04-01

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

  12. Results of the 2005-2008 Association of Residents in Radiation Oncology Survey of Chief Residents in the United States: Clinical Training and Resident Working Conditions

    International Nuclear Information System (INIS)

    Gondi, Vinai; Bernard, Johnny Ray; Jabbari, Siavash; Keam, Jennifer; Amorim Bernstein, Karen L. de; Dad, Luqman K.; Li, Linna; Poppe, Matthew M.; Strauss, Jonathan B.; Chollet, Casey T.

    2011-01-01

    Purpose: To document clinical training and resident working conditions reported by chief residents during their residency. Methods and Materials: During the academic years 2005 to 2006, 2006 to 2007, and 2007 to 2008, the Association of Residents in Radiation Oncology conducted a nationwide survey of all radiation oncology chief residents in the United States. Chi-square statistics were used to assess changes in clinical training and resident working conditions over time. Results: Surveys were completed by representatives from 55 programs (response rate, 71.4%) in 2005 to 2006, 60 programs (75.9%) in 2006 to 2007, and 74 programs (93.7%) in 2007 to 2008. Nearly all chief residents reported receiving adequate clinical experience in commonly treated disease sites, such as breast and genitourinary malignancies; and commonly performed procedures, such as three-dimensional conformal radiotherapy and intensity-modulated radiotherapy. Clinical experience in extracranial stereotactic radiotherapy increased over time (p < 0.001), whereas clinical experience in endovascular brachytherapy (p <0.001) decreased over time. The distribution of gynecologic and prostate brachytherapy cases remained stable, while clinical case load in breast brachytherapy increased (p = 0.006). A small but significant percentage of residents reported receiving inadequate clinical experience in pediatrics, seeing 10 or fewer pediatric cases during the course of residency. Procedures involving higher capital costs, such as particle beam therapy and intraoperative radiotherapy, and infrequent clinical use, such as head and neck brachytherapy, were limited to a minority of institutions. Most residency programs associated with at least one satellite facility have incorporated resident rotations into their clinical training, and the majority of residents at these programs find them valuable experiences. The majority of residents reported working 60 or fewer hours per week on required clinical duties

  13. 38 CFR 51.70 - Resident rights.

    Science.gov (United States)

    2010-07-01

    ... current clinical records within 24 hours (excluding weekends and holidays); and (ii) After receipt of his... the records or any portions of them upon request and with 2 working days advance notice to the... be a separate accounting for each resident's share.) (ii) Funds less than $100. The facility...

  14. Educational contracts in family medicine residency training.

    OpenAIRE

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

    1994-01-01

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

  15. 2009 Canadian Radiation Oncology Resident Survey

    Energy Technology Data Exchange (ETDEWEB)

    Debenham, Brock, E-mail: debenham@ualberta.net [Department of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta (Canada); Banerjee, Robyn [Department of Radiation Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta (Canada); Fairchild, Alysa; Dundas, George [Department of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta (Canada); Trotter, Theresa [Department of Radiation Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta (Canada); Yee, Don [Department of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta (Canada)

    2012-03-15

    Purpose: Statistics from the Canadian post-MD education registry show that numbers of Canadian radiation oncology (RO) trainees have risen from 62 in 1999 to approximately 150 per year between 2003 and 2009, contributing to the current perceived downturn in employment opportunities for radiation oncologists in Canada. When last surveyed in 2003, Canadian RO residents identified job availability as their main concern. Our objective was to survey current Canadian RO residents on their training and career plans. Methods and Materials: Trainees from the 13 Canadian residency programs using the national matching service were sought. Potential respondents were identified through individual program directors or chief resident and were e-mailed a secure link to an online survey. Descriptive statistics were used to report responses. Results: The eligible response rate was 53% (83/156). Similar to the 2003 survey, respondents generally expressed high satisfaction with their programs and specialty. The most frequently expressed perceived weakness in their training differed from 2003, with 46.5% of current respondents feeling unprepared to enter the job market. 72% plan on pursuing a postresidency fellowship. Most respondents intend to practice in Canada. Fewer than 20% of respondents believe that there is a strong demand for radiation oncologists in Canada. Conclusions: Respondents to the current survey expressed significant satisfaction with their career choice and training program. However, differences exist compared with the 2003 survey, including the current perceived lack of demand for radiation oncologists in Canada.

  16. [Resident evaluation of general surgery training programs].

    Science.gov (United States)

    Espinoza G, Ricardo; Danilla E, Stefan; Valdés G, Fabio; San Francisco R, Ignacio; Llanos L, Osvaldo

    2009-07-01

    The profile of the general surgeon has changed, aiming to incorporate new skills and to develop new specialties. To assess the quality of postgraduate General Surgery training programs given by Chilean universities, the satisfaction of students and their preferences after finishing the training period. A survey with multiple choice and Likert type questions was designed and applied to 77 surgery residents, corresponding to 59% of all residents of general surgery specialization programs of Chilean universities. Fifty five per cent of residents financed with their own resources the specialization program. Thirty nine percent disagreed partially or totally with the objectives and rotations of programs. The opportunity to perform surgical interventions and the support by teachers was well evaluated. However, 23% revealed teacher maltreatment. Fifty six percent performed research activities, 73% expected to continue training in a derived specialty and 69% was satisfied with the training program. Residents considered that the quality and dedication of professors and financing of programs are issues that must be improved. The opportunity to perform surgical interventions, obtaining a salary for their work and teacher support is considered of utmost importance.

  17. 2009 Canadian Radiation Oncology Resident Survey

    International Nuclear Information System (INIS)

    Debenham, Brock; Banerjee, Robyn; Fairchild, Alysa; Dundas, George; Trotter, Theresa; Yee, Don

    2012-01-01

    Purpose: Statistics from the Canadian post-MD education registry show that numbers of Canadian radiation oncology (RO) trainees have risen from 62 in 1999 to approximately 150 per year between 2003 and 2009, contributing to the current perceived downturn in employment opportunities for radiation oncologists in Canada. When last surveyed in 2003, Canadian RO residents identified job availability as their main concern. Our objective was to survey current Canadian RO residents on their training and career plans. Methods and Materials: Trainees from the 13 Canadian residency programs using the national matching service were sought. Potential respondents were identified through individual program directors or chief resident and were e-mailed a secure link to an online survey. Descriptive statistics were used to report responses. Results: The eligible response rate was 53% (83/156). Similar to the 2003 survey, respondents generally expressed high satisfaction with their programs and specialty. The most frequently expressed perceived weakness in their training differed from 2003, with 46.5% of current respondents feeling unprepared to enter the job market. 72% plan on pursuing a postresidency fellowship. Most respondents intend to practice in Canada. Fewer than 20% of respondents believe that there is a strong demand for radiation oncologists in Canada. Conclusions: Respondents to the current survey expressed significant satisfaction with their career choice and training program. However, differences exist compared with the 2003 survey, including the current perceived lack of demand for radiation oncologists in Canada.

  18. [Motivation and satisfaction of residents in urology].

    Science.gov (United States)

    Enzmann, T; Buxel, H; Benzing, F

    2010-08-01

    To address the increasing shortage of qualified residents, which leads to further discontent and additional on-call rotations for the remaining physicians, an analysis of the current situation was performed. Stress in the daily working routine, not enough free time, too little pay, or too little compensatory time off for overtime as well as inadequate options for continuing education were reported to be the main elements of dissatisfaction. The economic pressure of day-to-day work continues to define the physician's role and places demands on the medical staff by burdening them with nonmedical and administrative tasks.The major causes mentioned were staff shortage and lack of support provided by supervisors and the administration. For this reason, human resource development should be considered a strategic and central goal. This requires a normative, cross-functional approach at all levels of management and inclusion of personnel departments in the strategic processes of the hospital. The most important aspects for resident satisfaction were the work environment, acceptable work-life balance and remuneration, compensation for overtime, and quality of available continuing education, which is often rated as being insufficient.Effective strategies to improve the motivation of residents comprise offering opportunities for structured continuing education, optimizing the everyday work processes, and involving employees in social networks. The establishment of feedback strategies, including recognition of residents' achievements, will help to ensure their loyalty and identification with their clinic. This can serve as a preventive measure to offset any potential willingness to change jobs.

  19. Interior moisture design loads for residences

    Science.gov (United States)

    Anton TenWolde; Iain S. Walker

    2001-01-01

    This paper outlines a methodology to obtain design values for indoor boundary conditions for moisture design calculations for residences. This is part of a larger effort by ASHRAE Standard Project Committee 160P, Design Criteria for Moisture Control in Buildings, to formulate criteria for moisture design loads, analysis techniques, and material and building performance...

  20. Training in radiological protection of residents

    International Nuclear Information System (INIS)

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

    2013-01-01

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

  1. Otolaryngology Training for Family Practice Residents.

    Science.gov (United States)

    And Others; Rood, Stewart R.

    1980-01-01

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

  2. Mobbing Exposure of Anaesthesiology Residents in Turkey.

    Science.gov (United States)

    Aykut, Gülnihal; Efe, Esra Mercanoğlu; Bayraktar, Selcan; Şentürk, Sinem; Başeğmez, İrem; Özkumit, Özlem; Kabak, Elmas; Yavaşçaoğlu, Belgin; Bilgin, Hülya

    2016-08-01

    In recent years, psychological problems that are caused by working conditions, like burn out syndrome, are more commonly observed. In our study, we aimed to evaluate mobbing exposure, factors causing mobbing and precautions for mobbing in residency students who are educated in anaesthesiology and reanimation clinics in Turkey. After obtaining consent from the ethics committee, we sent our questionnaires to the secretariats of the departments by postal mail. Completed questionnaires were collected in our department's secretariat blindly and randomly mixed. One hundred and one participants were returned the questionnaires. Data was statistically analysed in SPSS 21.0 software programme. During residency programme, sated to have experienced mobbing one or more time. Interestingly, 5.9% participants complained of physical mobbing. Mobbing exposure was more common in females. The most serious new onset psychosomatic symptoms stated during residency were committing suicide (2%), addiction (16%), severe depression (18%), panic attack (8%), more accidents (7%) and tendency of violence (15%). In mobbing group there was statistically significant dissatisfaction rate. In professions where mobbing is common, incidences of psychiatric diseases and suicide attempts are high are increased. Who are under risk for experiencing mobbing should be noticed carefully to ensure good judgement and problems should be inspected objectively in a detailed manner. Anesthesiology societies and other medical professional societies should establish mobbing committees. Thus, mobbing problems can be resolved and healthy career oppurtunities can be presented to residents.

  3. Resident involvement in civilian tactical emergency medicine.

    Science.gov (United States)

    Ramirez, Mario Luis; Slovis, Corey M

    2010-07-01

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

  4. Current integrated cardiothoracic surgery residents: a Thoracic Surgery Residents Association survey.

    Science.gov (United States)

    Tchantchaleishvili, Vakhtang; LaPar, Damien J; Stephens, Elizabeth H; Berfield, Kathleen S; Odell, David D; DeNino, Walter F

    2015-03-01

    After approval by the Thoracic Surgery Residency Review Committee in 2007, 6-year integrated cardiothoracic surgery (I-6) residency programs have gained in popularity. We sought to assess and objectively quantify the level of satisfaction I-6 residents have with their training and to identify areas of improvement for future curriculum development. A completely anonymous, electronic survey was created by the Thoracic Surgery Residents Association that asked the responders to provide demographic information, specialty interest, and lifestyle priorities, and to rate their experience and satisfaction with I-6 residency. The survey was distributed nationwide to all residents in I-6 programs approved by the Accreditation Council for Graduate Medical Education. Of a total of 88 eligible I-6 residents, 49 completed the survey (55.7%). Career choice satisfaction was high (75.5%), as was overall satisfaction with integrated training (83.7%). The majority (77.6%) were interested in cardiac surgery. Overall, the responders reported sufficient time for life outside of the hospital (57.1%), but experienced conflicts between work obligations and personal life at least sometimes (75.5%). Early exposure to cardiothoracic surgery was reported as the dominant advantage of the I-6 model, whereas variable curriculum structure and unclear expectations along with poor integration with general surgery training ranked highest among perceived disadvantages. Current I-6 residents are largely satisfied with the integrated training model and report a reasonable work/life balance. The focused nature of training is the primary perceived advantage of the integrated pathway. Curriculum variability and poor integration with general surgery training are identified by residents as primary areas of concern. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Learning style preferences of surgical residency applicants.

    Science.gov (United States)

    Kim, Roger H; Gilbert, Timothy

    2015-09-01

    The learning style preferences of general surgery residents have been previously reported; there is evidence that residents who prefer read/write learning styles perform better on the American Board of Surgery In-Training Examination (ABSITE). However, little is known regarding the learning style preferences of applicants to general surgery residency and their impact on educational outcomes. In this study, the preferred learning styles of surgical residency applicants were determined. We hypothesized that applicant rank data are associated with specific learning style preferences. The Fleming VARK learning styles inventory was offered to all general surgery residency applicants that were interviewed at a university hospital-based program. The VARK model categorizes learners as visual (V), aural (A), read/write (R), kinesthetic (K), or multimodal (MM). Responses on the inventory were scored to determine the preferred learning style for each applicant. Applicant data, including United States Medical Licensing Examination (USMLE) scores, class rank, interview score, and overall final applicant ranking, were examined for association with preferred learning styles. Sixty-seven applicants were interviewed. Five applicants were excluded due to not completing the VARK inventory or having incomplete applicant data. The remaining 62 applicants (92%) were included for analysis. Most applicants (57%) had a multimodal preference. Sixty-nine percent of all applicants had some degree of preference for kinesthetic learning. There were statistically significant differences between applicants of different learning styles in terms of USMLE step 1 scores (P = 0.001) and USMLE step 2 clinical knowledge scores (P = 0.01), but not for class ranks (P = 0.27), interview scores (P = 0.20), or final ranks (P = 0.14). Multiple comparison analysis demonstrated that applicants with aural preferences had higher USMLE 1 scores (233.2) than those with kinesthetic (211.8, P = 0.005) or multimodal

  6. How do clinical competency committees use different sources of data to assess residents' performance on the internal medicine milestones?A mixed methods pilot study.

    Science.gov (United States)

    Ekpenyong, Andem; Baker, Elizabeth; Harris, Ilene; Tekian, Ara; Abrams, Richard; Reddy, Shalini; Park, Yoon Soo

    2017-10-01

    This study examines how Clinical Competency Committees (CCCs) synthesize assessment data to make judgments about residents' clinical performances. Between 2014 and 2015, after four six-month reporting periods to the Accreditation Council for Graduate Medical Education (ACGME), 7 of 16 CCC faculty at Rush University Medical Center completed questionnaires focused on their perspectives about rating