Implementation of a "Cases and Conundrums" Conference Among Early Career Internal Medicine Clinicians.
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SUBMITTER: Matulis JC
PROVIDER: S-EPMC8575519 | biostudies-literature | 2021 Nov-Dec
REPOSITORIES: biostudies-literature
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Implementation of a "Cases and Conundrums" Conference Among Early Career Internal Medicine Clinicians.
Matulis John C JC Barakat Suzette S
Annals of family medicine 20211101 6
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Project description:BACKGROUND: Morbidity and mortality (M&M) conferences provide a forum for discussing adverse events and systems-based practice (SBP) issues; however, few models for implementing multidisciplinary, systems-focused M&M conferences exist. OBJECTIVE: To implement a new systems-focused M&M conference and evaluate success in focusing on adverse events and systems issues in a nonpunitive, multidisciplinary manner. METHODS: We implemented a new M&M conference into our large university-based internal medicine residency program. Using content analysis, we qualitatively analyzed audio recordings of M&M conferences from the first year of implementation (2010-2011) to determine the frequency of adverse events (injury resulting from medical care), SBP discussion, and allocation of blame. Multidisciplinary attendance was evaluated by attendance logs. Surveys assessed change in interns' perceptions of M&M conferences before and after the conference series (measured by median Likert-scale response) and trainee/faculty attitudes regarding the goal of M&M conferences. RESULTS: There were 226 attendees (66 faculty, 160 residents/fellows) at 9 M&M conferences. Average attendance per conference was 71, with representation from 16 disciplines. All M&M conferences (100%) included adverse events, SBP discussion, and lacked explicit individual blame. Interns' perceptions improved, including their belief that the M&M conference's purpose is systems improvement (4.35 versus 4.71, P = .02) and complications are discussed without blame (3.81 versus 4.34, P = .01). After experiencing M&M conferences, trainees/faculty reported favorable ratings, including beliefs that the M&M conference is important for education (97%) and the purpose is systems improvement (95%). CONCLUSIONS: The implementation of a new systems-focused M&M conference resulted in a conference series focusing on adverse events and associated system issues in a nonpunitive, multidisciplinary context.
| S-EPMC3963772 | biostudies-other
Project description: Not available
| S-EPMC10463168 | biostudies-literature
Project description:BackgroundUnderstanding factors in internal medicine (IM) resident career choice may reveal important needed interventions for recruitment and diversity in IM primary care and its subspecialties. Self-reported learner confidence is higher in men than in women in certain areas of practicing medicine, but has never been explored as a factor in career choice.ObjectiveThe purpose of this study is to elucidate associations between confidence, gender, and career choice.DesignIM residents completed a 31-item survey rating confidence in procedural, clinical, and communication skills on a 9-point Likert scale. Residents also reported anticipated career choice and rated influence of factors. Associations between gender and confidence scale scores, gender and career choice, and confidence and career choice were analyzed using t tests, ANOVA, and multiple linear regression controlled for postgraduate year (PGY), institution, and specialty choice.Participants292 IM residents at Northwestern and University of Texas (UT) Southwestern MAIN MEASURES: Resident gender, self-reported confidence, career choice KEY RESULTS: Response rate was 79.6% (n = 292), of them 50.3% women. Overall self-reported confidence increased with training (PGY-1 4.9 (1.1); PGY-2 6.2 (1.0); PGY-3 7.4 (1.0); p < 0.001). Men had higher confidence than women (men 6.6 (1.5); women 6.3 (1.4), p = 0.06), with the greatest difference in procedures. High confidence in men was associated with choice of procedural careers, whereas there was no association between confidence and career in women.ConclusionsThis is the first study demonstrating a gender difference in self-reported confidence and career choice. There is a positive correlation in men: higher self-reported confidence with procedural specialties, lower with general internal medicine. Women's self-reported confidence had no association. Further investigation is needed to elucidate causative factors for differences in self-reported confidence by gender, and whether alterations in level of self-reported confidence produce a downstream effect on career choice.
| S-EPMC7947144 | biostudies-literature
Project description:BackgroundMorbidity and Mortality (M&M) conferences are widely utilized clinical teaching forums across the USA. Recent literature demonstrates heterogeneity in the educational objectives of M&M, with prior authors suggesting a variety of overarching purposes of the conference, including teaching quality improvement methods; promotion of patient safety; enhancement of clinical knowledge and skills; and reflection on humanistic aspects of medical practice. There is less information in the published literature regarding learning outcomes of M&M participants.ObjectiveThe goal of this study was to describe learning outcomes from the Internal Medicine Morbidity, Mortality, and Improvement conference at Dartmouth-Hitchcock Medical Center.DesignDirected content analysis of learning outcomes statements.ParticipantsInternal medicine physicians who requested Maintenance of Certification credit for one or more conference sessions during the 2017-2018 academic year.ApproachTwo independent reviewers analyzed 347 learning outcomes statements submitted by 49 conference participants. The reviewers used an iterative process to code content themes (the category of medical or healthcare delivery knowledge learned) and learning implementation domains (the context or manner in which learning would be applied), and to identify comments regarding the shared experience of practicing medicine.Key resultsSeventy-eight percent of comments described learning related to clinical knowledge and skills, and 28%, 34%, and 9% of comments described learning related to clinical reasoning skills, systems knowledge, and the need for systems change, respectively. Most conferences generated learning within a variety of themes and across multiple domains. Sixty-four percent of conferences included at least one reflection on the shared experience of practicing medicine.ConclusionsParticipants derived several types of learning from this Internal Medicine M&M conference. Although clinical knowledge and skills represent the most common type of learning, the conference also produces rich learning in other domains as well as reflections on the humility, challenges, and meaning of being a physician.
| S-EPMC9296807 | biostudies-literature
Project description:ImportanceFew data exist on internal medicine trainees' selection of cardiology training, although this is important for meeting future cardiology workforce needs.ObjectiveTo discover trainees' professional development preferences and perceptions of cardiology, and their relationship to trainees' career choice.Design, setting, and participantsWe surveyed trainees to discover their professional development preferences and perceptions of cardiology and the influence of those perceptions and preferences on the trainees' career choices. Participants rated 38 professional development needs and 19 perceptions of cardiology. Data collection took place from February 2009, through January 2010. Data analysis was conducted from May 2017 to December 2017.Main outcomes and measuresMultivariable models were used to determine the association of demographics and survey responses with prospective career choice.ResultsA total of 4850 trainees were contacted, and 1123 trainees (of whom 625 [55.7%] were men) in 198 residency programs completed surveys (23.1% response; mean [SD] age, 29.4 [3.5] years). Principal component analysis of survey responses resulted in 8-factor and 6-factor models. Professional development preferences in descending order of significance were stable hours, family friendliness, female friendliness, the availability of positive role models, financial benefits, professional challenges, patient focus, and the opportunity to have a stimulating career. The top perceptions of cardiology in descending order of significance were adverse job conditions, interference with family life, and a lack of diversity. Women and future noncardiologists valued work-life balance more highly and had more negative perceptions of cardiology than men or future cardiologists, who emphasized the professional advantages available in cardiology. Professional development factors and cardiology perceptions were strongly associated with a decision to pursue or avoid a career in cardiology in both men and women.Conclusions and relevanceAlignment of cardiology culture with trainees' preferences and perceptions may assist efforts to ensure the continued attractiveness of cardiology careers and increase the diversity of the cardiology workforce.
| S-EPMC6143073 | biostudies-literature
Project description:BackgroundLittle is known about factors contributing to the career decisions of internal medicine residents.ObjectiveTo evaluate factors self-reported by internal medicine residents nationally as important to their career decisions.DesignCross-sectional survey conducted in October of 2005, 2006, and 2007 as part of the national Internal Medicine In-Training Examination (IM-ITE).ParticipantsPostgraduate year 3 internal medicine residents taking the IM-ITE.MeasurementsResidents rated the importance of nine factors in their career decisions on 5-point Likert scales. Univariate statistics characterized the distribution of responses. Associations between variables were evaluated using Cochran-Mantel-Haenszel statistics for ordinal data. Multivariate analyses were conducted using logistic regression.ResultsOf 17,044 eligible residents taking the IM-ITE, 14,890 (87.4%) completed the career decision survey questions. Overall, time with family was the factor most commonly reported as of high or very high importance to career decisions (69.6%). Women were more likely to assign greatest importance to family time (OR 1.22, 95% confidence interval 1.12-1.31, p < 0.001) and long-term patient relationships (OR 1.34, 95% confidence interval 1.23-1.46, p < 0.001). Across debt levels, financial considerations were of greatest importance more often for residents owing >$150,000 (OR 1.33, 95% confidence interval 1.09-1.62, p < 0.001). Across specialties, mentor specialty was rated lowest in importance by residents pursuing hospitalist and general internal medicine careers.ConclusionsGreater attention to factors reported by residents as important to their career decisions may assist efforts to optimize the distribution of physicians across disciplines. In addition to lifestyle and practice considerations, these factors may include mentor specialty. As this factor is less commonly reported as important by residents planning careers in generalist fields, attention to effective mentoring may be an important element of efforts to increase interest in these areas.
| S-EPMC2710478 | biostudies-literature
Project description:Background Increasing demands on residents' time have made it critically important to maximize the effectiveness of didactic activities and motivate independent study. Objective Our aim was to correlate characteristics of noon conferences with internal medicine (IM) residents' ratings of perceived effectiveness and intent to pursue independent reading. Methods We assessed characteristics of each noon conference by direct observation using predetermined metrics. We surveyed IM residents to assess their perception of the conference's effectiveness and their intention to pursue additional reading. A variety of modeling techniques were used to discern meaningful correlations of effectiveness and motivation. Results A total of 649 evaluations of 29 conferences were submitted by 153 of 185 (83%) residents in the program. Median effectiveness score was 6 (on a scale of 1 to 7). Clinicopathological conferences had 0.55-point higher effectiveness scores than traditional conferences (P = .011). In multivariable analyses focusing on traditional conferences, summary statement inclusion was significantly associated with 0.43-point higher effectiveness scores (P = .016), and having resident speakers was associated with 0.50-point higher effectiveness scores than unfamiliar faculty (P = .045). Conferences with higher effectiveness scores had significantly higher proportions of respondents indicating intention to read. Conclusions This is the first study to quantitatively assess correlations of high effectiveness ratings of noon conferences in a residency program. Intention to read improved with increasing effectiveness scores of conferences, suggesting residents are more inclined to pursue self-directed learning when topics are well presented. Considering these attributes in designs of didactic sessions may enhance their educational value.
| S-EPMC4857508 | biostudies-literature
Project description:IntroductionHospital medicine is a growing field that focuses not only on expertise in inpatient medicine but also on knowledge of nonclinical health system topics. The traditional model for resident education does not lend itself to learning these topics. We developed a unique ward rotation with a dedicated curriculum called the Resident Inpatient Training Experience (RITE) to address this deficiency.MethodsThe RITE rotation was initially implemented in the 2013-2014 academic year. The curriculum accompanying the rotation contained four case-based modules that included content on patient safety, quality improvement, cost-conscious care, hospital metrics/reimbursement, physician billing and coding, and transitions of care. Prior to RITE, residents received an email orientation to the service. To evaluate the rotation and curriculum, residents completed a pre- and postrotation online survey. Forty-six upper PGY 2 residents each rotated on the service for 1 month. An experienced hospitalist attended on the service and facilitated a weekly discussion on each module. This publication includes an updated version of the email orientation, the four modules, and the surveys.ResultsThere was a 72% response rate for completion of the pre- and postrotation survey. Confidence in managing hospitalized patients and knowledge of module content taught during the rotation improved.DiscussionWe found that implementation of a hospital medicine rotation and curriculum improved resident independence and knowledge of the module topics and was a successful way to alleviate current deficiencies in resident education.
| S-EPMC7526505 | biostudies-literature
Project description:ObjectivesThe first combined emergency medicine/internal medicine (EM/IM) residency was established in 1991. As the 30th anniversary of this unique dual-training opportunity approaches, multiple changes to the practice and educational landscape have occurred. Previous surveys examining this topic are now more than 10 years old and occurred prior to the establishment of the EM/IM/critical care medicine (EM/IM/CCM) pathway. We conducted a survey to investigate career trajectories, satisfaction, and opportunities available to EM/IM graduates.MethodsSurvey questions were developed to both allow for comparison with previously published data and examine new topics not previously investigated. A group of EM/IM and EM/IM/CCM program directors validated the survey questions. Eligible respondents were identified and contacted through their previous residency program leadership.ResultsFifty-two percent (152/290) of graduates completed the survey. Thirty-seven percent of respondents practice both EM and IM, 51% practice EM only, and the remainder practice IM only. Thirty-one percent of total respondents completed a fellowship, with critical care being the most popular choice. Seventy-one percent of graduates practice in an academic center, and many hold leadership positions within education, research, and hospital administration. Eighty-seven percent of graduates were "extremely satisfied" with their choice to pursue EM/IM or EM/IM/CCM and 95% reported that they would choose this path again.ConclusionsMost respondents are satisfied with their residency choice and would choose to pursue this training again, despite the additional years of training. The proportion of graduates pursuing fellowship is higher than previously published data. Most continue to work in academics, and many are leaders within their institutions. The changing health care landscape offers multiple opportunities to dually trained graduates.
| S-EPMC8019212 | biostudies-literature
Project description:Professional and governmental organizations recommend an ideal US physician workforce composed of at least 40 % primary care physicians. They also support primary care residencies to promote careers in primary care. Our study examines the relationship between graduation from a primary care or categorical internal medicine residency program and subsequent career choice.We conducted a cross-sectional electronic survey of a cohort of internal medicine residency alumni who graduated between 2001 and 2010 from a large academic center. Our primary predictor was graduation from a primary care versus a categorical internal medicine program and our primary outcome is current career role. We performed chi-square analysis comparing responses of primary care and categorical residents.We contacted 481 out of 513 alumni, of whom 322 responded (67 %). We compared 106 responses from primary care alumni to 169 responses from categorical alumni. Fifty-four percent of primary care alumni agreed that the majority of their current clinical work is in outpatient primary care vs. 20 % of categorical alumni (p < 0.001). While 92.5 % of primary-care alumni were interested in a primary care career prior to residency, only 63 % remained interested after residency. Thirty of the 34 primary care alumni (88 %) who lost interest in a primary care career during residency agreed that their ambulatory experience during residency influenced their subsequent career choice.A higher percentage of primary care alumni practice outpatient primary care as compared to categorical alumni. Some alumni lost interest in primary care during residency. The outpatient clinic experience may impact interest in primary care.
| S-EPMC4539335 | biostudies-other