The use of the NEJM knowledge + online platform to supplement traditional pulmonary didactic: a resident-led educational quality improvement project at a community hospital IM GME program.
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SUBMITTER: Kaell A
PROVIDER: S-EPMC8221144 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:IntroductionParticipation in quality improvement (QI) projects is required of pediatric residents, and evidence-based medicine has highlighted the importance of providing residents with experiential practice in this realm. Embedding QI projects within a continuity clinic provides residents an opportunity for meaningful involvement in QI efforts.MethodsA QI curriculum was implemented within a pediatric residency program that included an introductory lecture on QI principles and participation in resident-led, team-based QI projects at an outpatient clinic. Residents designed, implemented, and analyzed projects beginning in their intern year. Projects operated on an accelerated, 6-month time frame, allowing residents to complete multiple projects over the course of their residency. Resident QI knowledge was assessed before and after an introductory lecture with the Quality Improvement Knowledge Application Tool (QIKAT). Resident feedback was solicited 1 year following curriculum implementation via anonymous online surveys.ResultsResidents completed four QI projects that produced meaningful improvements in clinic processes and patient care. QIKAT scores significantly increased after the introductory lecture. Residents reported that the curriculum afforded them increased confidence to implement plan-do-study-act cycles and improve patient care in their future practices. Qualitative feedback highlighted the team-based structure, participation in multiple projects, and visible direct impacts on patient care as strengths of the curriculum. Increased involvement of clinic staff, scheduling concerns, and improved communication were areas for improvement.DiscussionOur model for integrating resident-led QI projects into an ambulatory clinic rotation is feasible and has been well received by residents and impactful on clinic processes and care.
| S-EPMC6342353 | biostudies-literature
Project description:The time course of physicians' knowledge retention after learning activities has not been well characterized. Understanding the time course of retention is critical to optimizing the reinforcement of knowledge.Educational follow-up experiment with knowledge retention measured at 1 of 6 randomly assigned time intervals (0-55 days) after an online tutorial covering 2 American Diabetes Association guidelines.Internal and family medicine residents.Multiple-choice knowledge tests, subject characteristics including critical appraisal skills, and learner satisfaction.Of 197 residents invited, 91 (46%) completed the tutorial and were randomized; of these, 87 (96%) provided complete follow-up data. Ninety-two percent of the subjects rated the tutorial as "very good" or "excellent." Mean knowledge scores increased from 50% before the tutorial to 76% among those tested immediately afterward. Score gains were only half as great at 3-8 days and no significant retention was measurable at 55 days. The shape of the retention curve corresponded with a 1/4-power transformation of the delay interval. In multivariate analyses, critical appraisal skills and participant age were associated with greater initial learning, but no participant characteristic significantly modified the rate of decline in retention.Education that appears successful from immediate posttests and learner evaluations can result in knowledge that is mostly lost to recall over the ensuing days and weeks. To achieve longer-term retention, physicians should review or otherwise reinforce new learning after as little as 1 week.
| S-EPMC2517967 | biostudies-literature
Project description:BackgroundTraditional ambulatory training models have limitations in important domains, including opportunities for residents to learn, fragmentation of care delivery experience, and satisfaction with ambulatory experiences. New models of ambulatory training are needed.AimTo compare the impact of a traditional ambulatory training model with a templated 4?+?1 model.SettingA large university-based internal medicine residency using three different training sites: a patient-centered medical home, a hospital-based ambulatory clinic, and community private practices.ParticipantsResidents, faculty, and administrative staff.Program descriptionDevelopment of a templated 4?+?1 model of residency where trainees do not attend to inpatient and outpatient responsibilities simultaneously.Program evaluationA mixed-methods analysis of survey and nominal group data measuring three primary outcomes: 1) Perception of learning opportunities and quality of faculty teaching; 2) Reported fragmentation of care delivery experience; 3) Satisfaction with ambulatory experiences. Self-reported empanelment was a secondary outcome. Residents' learning opportunities increased (p?=?0.007) but quality of faculty teaching was unchanged. Participants reported less fragmentation in the care residents provide patients in the inpatient and outpatient setting (p?<?0.0001). Satisfaction with ambulatory training improved (p?<?0.0001). Self-reported empanelment also increased (p?<?0.0001). Results held true for residents, faculty, and staff at all three ambulatory training sites (p?<?0.0001).DiscussionA 4?+?1 model increased resident time in ambulatory continuity clinic, enhanced learning opportunities, reduced fragmentation of care residents provide, and improved satisfaction with ambulatory experiences. More studies of similar models are needed to evaluate effects on additional trainee and patient outcomes.
| S-EPMC3710374 | biostudies-literature
Project description:BackgroundEducational autopsy (EA) is an innovative technique designed to improve the quality of feedback provided to conference presenters. In response to survey fatigue and suboptimal feedback from online evaluations, this postlecture group debrief was adapted to emergency medicine residency didactics, with a goal of collecting timely, specific, and balanced feedback for presenters. Other aims include encouraging participants to think critically about educational methods and providing presenters with formal feedback for a portfolio or promotion packet. It was hypothesized that EA provides more specific and actionable feedback than traditional online evaluations deployed individually to conference attendees.MethodsThe authors analyzed 4 months of evaluations pre- and postimplementation of EA. Rate of completion, presence of comments, and types of comments were compared. Comments were coded as specific, nonspecific, and unrelated/unclear. Specific comments were further categorized as about audiovisual presentation design, speaker presentation style, and educational methods of the session.ResultsA total of 46 of 65 (71%) preimplementation presentations eligible for evaluation received comments through traditional online evaluations. A total of 44 of 75 (59%) eligible postimplementation presentations generated comments via EA. Among presentations that received comments, none received nonspecific comments via EA, compared to 46% of lectures through traditional evaluations. EA generated specific comments for more presentations regarding presentation design (91% vs. 63%), presentation style (66% vs. 24%), and educational methods (48% vs. 28%). EA produced no unclear comments; traditional evaluations resulted in unclear comments for 15% of lectures.ConclusionsEA generated more specific feedback for residency conference presenters, although there were a number of sessions not evaluated by EA. Although this limited analysis suggested that EA produced higher-quality presenter feedback, it also showed a drop-off in the proportion of didactic sessions that received narrative feedback.
| S-EPMC8239163 | biostudies-literature
Project description:BackgroundMany internal medicine programs have reorganized their resident continuity clinics to improve the ambulatory care experience for residents. The effect of this redesign on patient satisfaction is largely unknown.MethodsOur multi-institutional, cross-sectional study included 569 internal medicine residents from 11 programs participating in the Educational Innovations Project Ambulatory Collaborative. An 11-item patient satisfaction survey from the Consumer Assessment of Healthcare Providers and Systems was used to assess patient satisfaction, comparing patient satisfaction in traditional models of weekly continuity clinic with 2 new clinic models. We then examined the relationship between patient satisfaction and other practice variables.ResultsPatient satisfaction responses related to resident listening and communication skills, knowledge of medical history, perception of adequate visit time, overall rating, and willingness to refer to family and friends were significantly better in the traditional and block continuity models than the combination model. Higher ambulatory workload was associated with reduced patient perception of respect shown by the physician. The percentage of diabetic patients with glycated hemoglobin < 8% was positively correlated with number of visits, knowledge of medical history, perception of respect, and higher scores for recommending the physician to others. The percentage of diabetic patients with low density lipoprotein < 100 mg/dL was positively correlated with the physician showing respect.ConclusionsPatient satisfaction was similar in programs using block design and traditional models for continuity clinic, and both outperformed the combination model programs. There was a delicate balance between workload and patient perception of the physician showing respect. Care outcome measures for diabetic patients were associated with aspects of patient satisfaction.
| S-EPMC4535210 | biostudies-literature
Project description:The COVID-19 pandemic has forced higher-education institutions to shift to nearly 100% online delivery of didactic coursework nationally. Besides the stress and isolation that many students experience simply due to the physical distancing requirements imposed by the crisis, students new to learning in an online environment may feel further isolated and disengaged from the course content. Consequently, we explored the use of an existing online social networking tool, Instagram, to enhance students' engagement with online course material. In this study, students enrolled in both undergraduate and graduate online science courses were invited to participate. Course instructors posted materials related to the topics covered in the course weekly sessions, including links to news reports, cartoons, and short quizzes. At the conclusion of each course, a questionnaire focusing on the students' experience was distributed to all participants. Results from the survey showed that the weekly Instagram posts allowed students to feel more engaged with the course content and connected with the course instructors and classmates. However, some students reported that the posts were not helpful or that they did not feel comfortable using social networking tools for education purposes due to privacy concerns. In this article, we provide tips for how to improve the effectiveness of using social networking tools to augment didactic online courses.
| S-EPMC8060131 | biostudies-literature
Project description:BackgroundFormal education surrounding abortion care during pre-clinical years of medical school is limited and will likely decrease with the overturning of Roe v. Wade. This study describes and evaluates the impact of an original abortion didactic session implemented during the pre-clinical years of medical school.MethodsWe implemented a didactic session at the University of California Irvine outlining abortion epidemiology, pregnancy options counseling, standard abortion care, and the current legislative landscape surrounding abortion. The preclinical session also included an interactive, small group case-based discussion. Pre-session and post-session surveys were obtained to evaluate changes in participants' knowledge and attitudes and to collect feedback for future sessions.Results92 matched pre- and post-session surveys were completed and analyzed (response rate 77%). The majority of the respondents identified themselves as more "pro-choice" compared to "pro-life" on the pre-session survey. Results reflected significantly increased comfort discussing abortion care and significantly increased knowledge about abortion prevalence and techniques after the session. Qualitative feedback was overwhelmingly positive and reflected participants' appreciation for the focus on the medical aspects of abortion care as opposed to an ethical discussion.ConclusionsAbortion education targeted to preclinical medical students can be implemented effectively by a medical student cohort with institutional support.
| S-EPMC10266871 | biostudies-literature
Project description:BackgroundSeveral professional societies have made value-based statements in support of restrictive transfusion strategies. The aim of this study was to determine whether completion of an accredited online training program in transfusion safety could improve transfusion knowledge among medical residents and increase transfusion appropriateness.MethodsWe performed a controlled before-after evaluation of a mandatory accredited self-directed training program (Bloody Easy Lite for Physicians) that provides education about transfusion medicine on a 47-bed medical clinical teaching unit at a university-affiliated hospital centre in Montréal. The program consists of 2 modules and takes about 30 minutes to complete. We used the 45-bed medical teaching unit at another Montréal hospital as a contemporary control. We compared resident physicians' pre- and posttest scores and evaluated the impact on transfusion appropriateness by comparing the proportion occurring below a hemoglobin concentration of 80 g/L before (April 2013-June 2015) and after (July 2015-January 2016) the intervention.ResultsOf the 55 residents on the intervention unit, 53 (96%) completed the training. The median pretest score was 50% (inter-quartile range [IQR] 40%-60%). The median posttest score was 90% (IQR 80%-90%) for module 1 and 80% (IQR 80%-90%) for module 2 (p < 0.001 for both pre-post comparisons). The proportion of transfusions below 80 g/L increased from 80.1% to 86.9% (p = 0.04) on the intervention unit and remained relatively unchanged on the control unit (75.6% v. 71.1%, p = 0.4). Although there was no statistically significant difference between the units in the proportion of transfusions below 80 g/L before the intervention (p = 0.07), a significant difference was observed after the intervention (p = 0.002).InterpretationMandatory training in transfusion safety via an online program resulted in improved transfusion knowledge among residents and an increase in the proportion of transfusions occurring at a hemoglobin concentration below 80 g/L. This low-cost educational initiative may improve transfusion appropriateness.
| S-EPMC6658213 | biostudies-literature
Project description:IntroductionConsistent medical knowledge acquisition while caring for the critically ill can be challenging for learners and educators in the pediatric intensive care unit (PICU), a unit often distinguished by fluctuating acuity and severity. We implemented a standardized didactic curriculum for PICU residents to facilitate their acquisition and retention of knowledge in core PICU topics.MethodsWe developed a comprehensive standardized curriculum for PGY 2-PGY 4 PICU pediatric and internal medicine-pediatric residents. Thirteen core topics were administered as 30-minute didactic sessions during the rotation, using either PowerPoint slides or a dry-erase board. Residents were tested to assess knowledge acquisition and retention.ResultsSeventy-eight residents participated, 86% of whom completed posttests. Seventeen percent completed follow-up tests. Of the learners who participated, 60 (77%) completed pretests and posttests, indicating their confidence level each time. The pretest mean was 55% (SD = 14.4%), and the posttest mean was 64% (SD = 15.6%). This 9% increase was statistically significant (p = .001; CI, 3.9% to 14.8%). The follow-up test at 3 months, completed by 15% of this subgroup, demonstrated a mean score of 62% (SD = 14.5%). When matched with posttest scores (mean score of 64%, SD = 13.3%), there was no significant difference (p = .7398; CI, -11.7% to 16.2%), suggesting retention of previously acquired knowledge.DiscussionOur standardized didactic curriculum effectively facilitated the acquisition and retention of the medical knowledge of core PICU topics among PICU residents, in addition to their usual experiential learning.
| S-EPMC7566227 | biostudies-literature
Project description:BackgroundDuty hour restrictions for resident physicians have led to radical changes in graduate medical education, including a shift to more night float rotations. These rotations have been viewed by residents as predominantly service focused with little opportunity for formalized education.ObjectiveTo develop and deliver a resident-driven, nocturnal curriculum to enhance the educational content and value of night float rotations.MethodsThe Hospital of the University of Pennsylvania is a 695-bed, tertiary care academic medical center. Upper-level internal medicine residents developed and peer-reviewed case-based scripts designed to be delivered in 15- to 20-minute teaching sessions. We evaluated the quality of teaching using anonymous, free-response surveys.ResultsTwenty-four scripts were developed that explored the differential diagnoses, diagnostic pitfalls, and management of clinical problems that interns frequently encounter on night float rotations. Of 83 eligible residents, 45 (54%) responded to the survey. Teaching occurred an average of 4 nights per week and was uniformly viewed as high yield and topical by night float interns.ConclusionsA resident-driven, nocturnal curriculum was implemented through the use of case-based teaching scripts, allowing for delivery of a standardized curriculum that capitalizes on the teaching opportunities afforded by the night shift. This intervention may serve as a model for nocturnal education in other departments and institutions.
| S-EPMC4597954 | biostudies-literature