A pilot study assessing knowledge of clinical signs and physical examination skills in incoming medicine residents.
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ABSTRACT:
SUBMITTER: Ramani S
PROVIDER: S-EPMC2930313 | biostudies-other | 2010 Jun
REPOSITORIES: biostudies-other
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Project description:BackgroundThe long-term retention of knowledge and skills in bedside ultrasound by internal medicine residents after ultrasound training is not well understood.ObjectiveWe sought to determine whether knowledge and skills acquired from focused training in bedside ultrasound are retained over time, and whether retention is related to independent practice.MethodsWe conducted a prospective observational trial of 101 internal medicine residents at an academic medical center who participated in a bedside ultrasound workshop followed by 12 months of independent practice. Performance was measured on image-based knowledge and skills assessment using direct observation, both before the workshop and 12 months later. Individual usage data were obtained along with a survey on attitudes toward bedside ultrasound.ResultsParticipants' mean knowledge assessment score increased from a baseline of 63.7% to 84.5% immediately after training (P < .001). At 12 months, mean knowledge score fell to 73.0%, significantly different from both prior assessments (P < .001). Despite knowledge decline, the mean skills assessment score improved from a baseline of 30.5% to 50.4% at 12 months (P < .001). Residents reporting more ultrasound use (> 25 examinations) had higher scores in baseline knowledge and skills assessments than those with lower usage (< 25 examinations). Change in knowledge and image acquisition skills between assessments was equal in both subgroups.ConclusionsResidents' knowledge of ultrasound improved after brief training but decayed over time, whereas skills showed marginal improvement over the study, with minimal support. Growth and retention of ultrasound abilities were not impacted by usage rates.
| S-EPMC5058588 | biostudies-literature
Project description:BACKGROUND: The number of older adults needing primary care exceeds the capacity of trained geriatricians to accommodate them. All physicians should have basic knowledge of optimal outpatient care of older adults to enhance the capacity of the system to serve this patient group. To date, there is no knowledge-assessment tool that focuses specifically on geriatric ambulatory care. OBJECTIVE: We developed an examination to assess internal medicine residents' knowledge of ambulatory geriatrics. METHODS: A consensus panel developed a 30-question examination based on topics in the American Board of Internal Medicine (ABIM) Certification Examination Blueprint, the ABIM in-training examinations, and the American Geriatrics Society Goals and Objectives. Questions were reviewed, edited, and then administered to medical students, internal medicine residents, primary care providers, and geriatricians. RESULTS: Ninety-eight individuals (20 fourth-year medical students, 57 internal medicine residents, 11 primary care faculty members, and 10 geriatrics fellowship-trained physicians) took the examination. Based on psychometric analysis of the results, 5 questions were deleted because of poor discriminatory power. The Cronbach α coefficient of the remaining 25 questions was 0.48; however, assessment of interitem consistency may not be an appropriate measure, given the variety of clinical topics on which questions were based. Scores increased with higher levels of training in geriatrics (P < .001). CONCLUSION: Our preliminary study suggests that the examination we developed is a reasonably valid method to assess knowledge of ambulatory geriatric care and may be useful in assessing residents.
| S-EPMC3886473 | biostudies-other
Project description:IntroductionThe last 10-15 years has seen a decline in formal undergraduate urological education throughout Canada. Given the large volume of urological presentations in family practice, trainees need to acquire the requisite urological knowledge and skills to serve their patients. The objective of this study is to determine the perceived level of urological knowledge and skills among Canadian family medicine residents.MethodsA 15-item, anonymous, online survey was distributed via email to all Canadian family medicine program directors from September to December 2018 and distributed to their residents. The survey obtained data on demographics, training, undergraduate urology experience, self-reported proficiency in interpreting urological investigations, performing common urological procedures, and managing common urological conditions. Descriptive statistics were used to summarize data.ResultsThe questionnaire was completed by 142 family medicine residents with representation from Western Canada (27.5%), Ontario (32.4%), and Quebec (40.1%); 39.4% of respondents had completed a urology rotation during medical school and only 29.1% felt that their medical training prepared them for the urological aspects of family medicine. Although the majority of respondents felt proficient in performing a digital rectal examination (58.5%) or managing urinary tract infections (97.9%), only a minority felt competent in performing male genitourinary examination (40.1%), uncomplicated male (34.5%), female (45.8%) or difficult (9.2%) urethral catheterization. Likewise, the minority of respondents felt comfortable managing erectile dysfunction (41.5%), scrotal swelling (34.7%), and scrotal pain (25.7%).ConclusionsThere are significant deficiencies in urological knowledge and skills among family medicine residents in Canada, possibly because of insufficient educational experiences during medical training.
| S-EPMC7704087 | biostudies-literature
Project description:BackgroundThe Accreditation Council for Graduate Medical Education Clinical Learning Environment Review program requires residents to receive training in handoffs, but there is limited information on best practices in implementing handoff training.ObjectiveWe hypothesized that a bundled, standardized approach to handoffs during intern orientation would increase trainee comfort, confidence, and knowledge.MethodsAll incoming internal medicine interns participated in a Care Transitions workshop during orientation that was divided into 3 sections: introduction and handoff videos using the I-PASS handoff tool, small group discussion of case scenarios, and a 1-on-1 handoff simulation with an evaluator. Participants completed pre- and postworkshop surveys. We reviewed handoff documents to assess whether residents continued to report illness severity-a key component of I-PASS-after the intervention.ResultsOver 3 years, 225 of 229 (98%) interns completed the preworkshop survey, and 191 (83%) completed the postworkshop survey. Between 2014 and 2016, the number of incoming interns reporting prior training in handoffs during medical school increased from 45% to 63%. Interns' self-reported comfort with providing effective handoffs and self-reported confidence identifying factors essential to an effective verbal handoff (measured on a 5-point Likert scale) improved significantly after the intervention (P < .05 for all questions and years). During 1 year, written handoffs for 28?498 patients were analyzed, and I-PASS illness severity was documented 99.4% of the time.ConclusionsThe Care Transitions workshop consistently improved comfort, confidence, and knowledge of interns in performing handoffs and resulted in sustained change in handoff documentation.
| S-EPMC6314362 | biostudies-literature
Project description:BackgroundTargeted interventions have improved physical activity and wellness of medical residents. However, no exercise interventions have focused on emergency medicine residents.ObjectiveThis study aimed to measure the effectiveness of a wearable device for tracking physical activity on the exercise habits and wellness of this population, while also measuring barriers to adoption and continued use.MethodsThis pre-post cohort study enrolled 30 emergency medicine residents. Study duration was 6 months. Statistical comparisons were conducted for the primary end point and secondary exercise end points with nonparametric tests. Descriptive statistics were provided for subjective responses.ResultsThe physical activity tracker did not increase the overall self-reported median number of days of physical activity per week within this population: baseline 2.5 days (interquartile range, IQR, 1.9) versus 2.8 days (IQR 1.5) at 1 month (P=.36). There was a significant increase in physical activity from baseline to 1 month among residents with median weekly physical activity level below that recommended by the Centers for Disease Control and Prevention at study start, that is, 1.5 days (IQR 0.9) versus 2.4 days (IQR 1.2; P=.04), to 2.0 days (IQR 2.0; P=.04) at 6 months. More than half (60%, 18/30) of participants reported a benefit to their overall wellness, and 53% (16/30) reported a benefit to their physical activity. Overall continued use of the device was 67% (20/30) at 1 month and 33% (10/30) at 6 months.ConclusionsThe wearable physical activity tracker did not change the overall physical activity levels among this population of emergency medicine residents. However, there was an improvement in physical activity among the residents with the lowest preintervention physical activity. Subjective improvements in overall wellness and physical activity were noted among the entire study population.
| S-EPMC5309436 | biostudies-literature
Project description:BACKGROUND:Colorectal cancer (CRC) is the third most common type of cancer and the second leading cause of cancer death in the United States. About one in three adults in the United States is not getting the CRC screening as recommended. Internal medicine residents are deficient in CRC screening knowledge. OBJECTIVE:The objective of our study was to assess the improvement in internal medicine residents' CRC screening knowledge via a pilot approach using a smartphone app. METHODS:We designed a questionnaire based on the CRC screening guidelines of the American Cancer Society, American College of Gastroenterology, and US Preventive Services Task Force. We emailed the questionnaire via a SurveyMonkey link to all the residents of an internal medicine department to assess their knowledge of CRC screening guidelines. Then we designed an educational intervention in the form of a smartphone app containing all the knowledge about the CRC screening guidelines. The residents were introduced to the app and asked to download it onto their smartphones. We repeated the survey to test for changes in the residents' knowledge after publication of the smartphone app and compared the responses with the previous survey. We applied the Pearson chi-square test and the Fisher exact test to look for statistical significance. RESULTS:A total of 50 residents completed the first survey and 41 completed the second survey after publication of the app. Areas of CRC screening that showed statistically significant improvement (P<.05) were age at which CRC screening was started in African Americans, preventive tests being ordered first, identification of CRC screening tests, identification of preventive and detection methods, following up positive tests with colonoscopy, follow-up after colonoscopy findings, and CRC surveillance in diseases. CONCLUSIONS:In this modern era of smartphones and gadgets, developing a smartphone-based app or educational tool is a novel idea and can help improve residents' knowledge about CRC screening.
| S-EPMC5871737 | biostudies-literature
Project description:BackgroundHealth care educators need valid and reliable tools to assess evidence based practice (EBP) knowledge and skills. Such instruments have yet to be developed for use among physical therapists. The Fresno Test (FT) has been validated only among general practitioners and occupational therapists and does not assess integration of research evidence with patient perspectives and clinical expertise. The purpose of this study was to develop and validate a modified FT to assess EBP knowledge and skills relevant to physical therapist (PT) practice.MethodsThe FT was modified to include PT-specific content and two new questions to assess integration of patient perspectives and clinical expertise with research evidence. An expert panel reviewed the test for content validity. A cross-sectional cohort representing three training levels (EBP-novice students, EBP-trained students, EBP-expert faculty) completed the test. Two blinded raters, not involved in test development, independently scored each test. Construct validity was assessed through analysis of variance for linear trends among known groups. Inter and intra-rater reliability, internal consistency, item discrimination index, item total correlation, and difficulty were analyzed.ResultsAmong 108 participants (31 EBP-novice students, 50 EBP-trained students, and 27 EBP-expert faculty), there was a statistically significant (p < 0.0001) difference in total score corresponding to training level. Total score reliability and psychometric properties of items modified for discipline-specific content were excellent [inter-rater (ICC (2,1)] = 0.91); intra-rater (ICC (2,1)] = 0.95, 0.96)]. Cronbach's alpha was 0.78. Of the two new items, only one had strong psychometric properties.ConclusionsThe 13-item modified FT presented here is a valid, reliable assessment of physical therapists' EBP knowledge and skills. One new item assesses integration of patient perspective as part of the EBP model. Educators and researchers may use the 13-item modified FT to evaluate PT EBP curricula and physical therapists' EBP knowledge and skills.
| S-EPMC2896364 | biostudies-literature
Project description:Background:This study evaluates the generalizability of an eight-station progress clinical skills examination and assesses the growth in performance for six clinical skills domains among first- and second-year medical students over four time points during the academic year. Methods:We conducted a generalizability study for longitudinal and cross-sectional comparisons and assessed growth in six clinical skill domains via repeated measures ANOVA over the first and second year of medical school. Results:The generalizability of the examination domain scores was low but consistent with previous studies of data gathering and communication skills. Variations in case difficulty across administrations of the examination made it difficult to assess longitudinal growth. It was possible to compare students at different training levels and the interaction of training level and growth. Second-year students outperformed first-year students, but first-year students' clinical skills performance grew faster than second-year students narrowing the gap in clinical skills over the students' first year of medical school. Conclusions:Case specificity limits the ability to assess longitudinal growth in clinical skills through progress testing. Providing students with early clinical skills training and authentic clinical experiences appears to result in the rapid growth of clinical skills during the first year of medical school.
| S-EPMC7197398 | biostudies-literature
Project description:IntroductionUpdating the method for evaluating suturing and scaling skills in dental education has attracted relatively little attention and there is no consensus to what should be assessed and how. The purpose of this study was to investigate the applicability of the Objective Structured Assessment of Technical Skill (OSATS) method for these two basic skills, the possible association between the scores and demographic factors, and the level of satisfaction of residents with this method.MethodsAll six periodontics and three oral medicine residents were recruited by census method and video-recorded while performing a simple interrupted suture, a figure eight suture and scaling on a model. Then, the videos were evaluated independently via a checklist and a global rating scale (GRS) by two expert raters. Agreement between raters and residents' satisfaction were evaluated. Correlation between demographic factors of participants and scores was also assessed. T-test and linear regression analysis were used.ResultsThere was no significant difference between the scores based on the views of the two raters for each of the checklist (ICC = 0.99, CI = 0.96-0.99, P < 0.001) and GRS (ICC = 0.97, CI = 0.86-0.99, P < 0.001). Linear regression showed no correlation between gender and scores but periodontics major and higher year of education showed correlation with higher scores.ConclusionConsidering the excellent agreement between raters in using both the checklist and GRS components of OSATS, and satisfaction of 88% the residents with this method, it seems to be able to provide a reliable assessment.
| S-EPMC10664488 | biostudies-literature
Project description:We evaluated the effectiveness of text messaging versus email, as a delivery method to enhance knowledge retention of emergency medicine (EM) content in EM residents. We performed a multi-centered, prospective, randomized study consisting of postgraduate year (PGY) 1 to PGY 3 & 4 residents in three United States EM residency programs in 2014. Fifty eight residents were randomized into one delivery group: text message or email. Participants completed a 40 question pre- and post-intervention exam. Primary outcomes were the means of pre- and post-intervention exam score differences. Data were analyzed using descriptive statistics, paired t-test, and multiple linear regressions. No significant difference was found between the primary outcomes of the two groups (P=0.51). PGY 2 status had a significant negative effect (P=0.01) on predicted exam score difference. Neither delivery method enhanced resident knowledge retention. Further research on implementation of mobile technology in residency education is required.
| S-EPMC5121189 | biostudies-literature