Pilot program using medical simulation in clinical decision-making training for internal medicine interns.
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ABSTRACT:
SUBMITTER: Miloslavsky EM
PROVIDER: S-EPMC3546580 | biostudies-other | 2012 Dec
REPOSITORIES: biostudies-other
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Project description:BackgroundUncertainty is common and impacts both patients and clinicians. The approach to uncertainty in medical trainees may be distinct from that of practicing clinicians and has important implications for medical education.ObjectiveDescribe trainee approach to uncertainty with the use of chart-stimulated recall (CSR)-based interviews, as well as the utility of such interviews in promoting reflection about decision-making among senior internal medicine (IM) residents.DesignQualitative analysis of CSR-based interviews with IM residents.ParticipantsSenior IM residents rotating on inpatient night float at the University of Pittsburgh Medical Center from February to September 2019.InterventionEach participant completed one, 20-min CSR session based on a self-selected case in which there was uncertainty in decision-making. Interviews explored the sources of, approaches to, and feelings about uncertainty.ApproachTwo independent coders developed a codebook and independently coded all transcripts. Transcripts were then analyzed using thematic analysis.Key resultsThe perceived acuity of the patient presentation was the main driver of the approach to and stress related to uncertainty. Perceived level of responsibility in resolving uncertainty during the overnight shift also varied among individual participants. Attending expression of uncertainty provided comfort to residents and alleviated stress related to uncertainty. Residents felt comfortable discussing their uncertainty and felt that the opportunity to think aloud during the exercise was valuable.ConclusionsOur study demonstrated a novel approach to the exploration of uncertainty in medical decision-making, with the use of CSR. Variations in resident perceived level of responsibility in resolving uncertainty during the overnight shift suggest a need for curriculum development in approach to uncertainty during night shifts. Though residents often experienced stress related to uncertainty, attending expression of uncertainty was an important mitigator of that stress, emphasizing the important role that the trainee-attending interaction plays in the diagnostic process.
| S-EPMC9485402 | biostudies-literature
Project description:PURPOSE:To investigate the associations between program-level variables such as organizational structure, workload, and learning environment and residents' development of depressive symptoms during internship. METHOD:Between 2012 and 2015, 1,276 internal medicine interns from 54 U.S. residency programs completed the Patient Health Questionnaire-9 (PHQ-9) before internship, and then quarterly throughout the internship. The training environment was assessed via a resident questionnaire and average weekly work hours. The authors gathered program structural variables from the American Medical Association Fellowship and Residency Electronic Interactive Database (FREIDA online) and program research rankings from Doximity. Associations between program-level variables and change in depressive symptoms were determined using stepwise linear regression modeling. RESULTS:Mean program PHQ-9 scores increased from 2.3 at baseline to 5.9 during internship (mean difference 3.6; SD 1.4; P < .001), with the mean increase ranging from -0.3 to 8.8 (interquartile range 1.1) among included programs. In multivariable models, faculty feedback (β = -0.37; 95% CI: -0.62, -0.12; P = .005), learning experience in inpatient rotations (β = -0.28; 95% CI: -0.54, -0.02; P = .030), work hours (β = 0.34; 95% CI: 0.13, 0.56; P = .002), and research ranking position (β = -0.25; 95% CI: -0.47, -0.03; P = .036) were associated with change in depressive symptoms. CONCLUSIONS:Poor faculty feedback and inpatient learning experience, long work hours, and high institutional research rankings were associated with increased depressive symptoms among internal medicine interns. These factors may be potential targets for interventions to improve wellness and mental health among these professionals.
| S-EPMC6538448 | biostudies-literature
Project description:BackgroundBurnout is a serious concern in graduate medical education. While enhancing resilience in trainees is considered beneficial, there are few studies showing successful interventions.ObjectiveWe developed and implemented a curriculum to teach resilience skills to internal medicine (IM) residents.MethodsOur resilience curriculum focused on 4 small group skill-building workshops: setting realistic goals, managing expectations, letting go after stressful clinical events, and finding gratitude. All sessions were delivered by a chief resident during dedicated teaching time, and combined lectures, group discussions, reflection, and simulated skill-building exercises. Participants were assessed before and after the curriculum using the Connor-Davidson Resilience Scale.ResultsOver a period of 2 years, 81 interns participated; 75% (61 of 81) responded prior to participating in the curriculum, and 79% (64 of 81) responded after participation. The majority thought sessions should continue the following year (75%, 48 of 64). Postsession, participants were more comfortable talking about stress and burnout (70%, 44 of 63), were more comfortable talking about medical errors (73%, 46 of 63), and had learned new ways to approach challenges (64%, 41 of 64). Mean resilience scores were lower after the curriculum (72.54 ± 10.18 versus 68.65 ± 10.14, P = .034). Feedback from participants indicated that the sessions fostered a sense of togetherness among peers and provided them with an additional support system.ConclusionsSmall group resilience workshops were feasible over 2 years and well received by IM interns, who noted gaining new skills to approach challenges. There was no improvement in resilience scores after the sessions.
| S-EPMC5646918 | biostudies-literature
Project description:BACKGROUND:Graduate medical education is shifting from the traditional apprenticeship model to a competency-driven model. Here we describe the design and implementation of competency-based medical education (CBME) in an internal medicine residency program, and report satisfaction survey results. METHODS:We redesigned the residency curriculum as CBME to be resident-centred, systematic, focused on general internal medicine, to provide experience in various care setting, and work-based assessment. In the second year of this CBME transition, we surveyed residents' overall satisfaction using 5-point Likert scale. Feedback on their training program was also analysed. RESULTS:The overall satisfaction score was 3.24 and thirteen residents (61.9%) answered that the preceptor's practical training in an educational atmosphere and improvement through training were the merits of the training program. However, residents complained about the working condition such as work overload. CONCLUSION:With the CBME implementation, most residents expressed satisfaction with the hospital's educational environment but they suffered from overwork. Further efforts to improve the educational program and environment are warranted.
| S-EPMC6660321 | biostudies-other
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:IntroductionMany women of reproductive age with complex medical conditions receive primary care through an internal medicine (IM) physician rather than an obstetrician/gynecologist. Long-acting reversible contraception methods are the most effective form of contraception; however, IM residents are not routinely trained in them. Infrequent training in, inadequate knowledge of, and discomfort with contraception counseling limit the counseling performed by IM residents. Shared decision-making (SDM) is a method of patient-centered communication that can improve communication about patient preferences and increase patient satisfaction with and adherence to contraception. We developed a curriculum to teach contraception counseling under the framework of SDM for IM residents.MethodsThe curriculum focused on contraception counseling through the lens of SDM designed for IM and medicine/pediatrics residents (PGY 2-PGY 4). We adapted an existing seven-step model of SDM to fit elements of contraception counseling. The curriculum consisted of a didactic teaching session with integration of an instructional video and structured interactive discussion. The session lasted 60 minutes.ResultsFifty-eight residents participated in the curriculum. On pre- and postcurriculum surveys, residents reported improvement in contraception knowledge (overall mean precurriculum = 57%, postcurriculum = 70%, p < .001) and comfort with contraception counseling (overall mean precurriculum = 3.2, postcurriculum = 3.6, p < .01). Residents expressed strong support for SDM before and after the curriculum.DiscussionBased on the survey results, the curriculum successfully addressed gaps in residents' comfort with contraception counseling and knowledge of contraception side effects and efficacy.
| S-EPMC7727611 | biostudies-literature
Project description:BACKGROUND: Public health training has become an important aspect of residency education. The Institute of Medicine recommends public health training for all resident physicians, and internal medicine educational milestones include general public health skills. OBJECTIVE: We sought to integrate community health into internal medicine residency training by developing a community health elective (CHE) curriculum. METHODS: We developed a 2-week CHE curriculum for internal medicine residents, featuring facilitated discussion sessions, clinical experience at health centers targeting medically underserved populations, and a culminating presentation. We evaluated our pilot curriculum using pre-elective and postelective course surveys with Likert-type questions. RESULTS: Of 150 eligible residents, 32 (21%) enrolled in the elective. Nearly all participants (30 of 32, 94%) strongly agreed that learning about community health was an important part of their residency training. Residents' perceived competence at discharging hospital patients with follow-up at community health sites increased 13-fold after taking the elective (P < .001). There was no increase in reported likelihood to practice in an underserved community or in primary care. CONCLUSIONS: The CHE addresses several Accreditation Council for Graduate Medical Education competencies and internal medicine Milestones and could be a replicable model for internal medicine residency programs that seek to provide community health training.
| S-EPMC3886472 | biostudies-other
Project description:BackgroundSince 1992 ART clinics have been required to report outcome data. Our objective was to assess practitioners' opinions of the impact of public reporting of assisted reproductive technology (ART) outcomes on treatment strategies, medical decision-making, and fellow training.MethodsSurvey study performed in an academic medical center. Members of the Society of Reproductive Endocrinology and Infertility and the Society of Reproductive Surgery were recruited to participate in an online survey in April 2012.: Categorical survey responses were expressed as percentages. Written responses were categorized according to common themes regarding effects of reporting on participants' medical management of patients. The study was primarily qualitative and was not powered to make statistical conclusions.ResultsOf 1019 surveys sent, 323 participants (31.7%) responded from around the United States, and 275 provided complete data. Nearly all (273 of 282; 96.8%) participants responded that public reporting sometimes or always affected other providers' practices, and 264 of 281 (93.9%) responded that other practitioners were motivated to deny care to poor-prognosis patients to improve reported success rates. However, only 121 of 282 (42.9%) indicated that public reporting influenced their own medical management. The majority of respondents agreed that public reporting may hinder adoption of single embryo transfer practices (194 of 299; 64.9%) and contribute to the persistent rate of twinning in in vitro fertilization (187 of 279; 67%). A small majority (153 of 279; 54.8%) felt that public reporting did not benefit fellow training, and 58 (61.7%) of the 94 participants who trained fellows believed that having fellows perform embryo transfers reduced pregnancy rates. A small majority (163 of 277; 58.8%) of respondents reported their ART success rates on clinical websites. However, the majority (200 of 275; 72.7%) of respondents compared their success rates with those of other clinics. Finally, most respondents (211 of 277; 76%) believed that most centers that advertised their success rates did so in ways that were misleading to patients.ConclusionsPublic reporting of ART clinical outcomes is intended to drive improvement, promote trust between patients and providers, and inform consumers and payers. However, providers reported that they modified their practices, felt others denied care to poor-prognosis patients, and limited participation of trainees in procedures in response to public reporting of ART outcomes.
| S-EPMC7014742 | biostudies-literature
Project description:ObjectiveSimulation-based learning strategies have demonstrated improved procedural competency, teamwork skills, and acute patient management skills in learners. "Boot camp" curricula have shown immediate and delayed performance in surgical and medical residents. We created a 5-day intensive, simulation and active learning-based curriculum for internal medicine interns to address perceived gaps in cognitive, affective and psychomotor domains. Intern confidence and self-perceived competence was assessed via survey before and after the curriculum, along with qualitative data.ResultsA total of 33 interns completed the curriculum in 2014, 32 in 2015. Interns had a significant increase in confidence and self-perceived competence in procedural, cognitive and affective domains (all p values?<?.05).
| S-EPMC6302521 | biostudies-literature
Project description:Introduction:Emergency Medicine is a medical specialty based on knowledge and skills required for the prevention, diagnosis and management of the acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioural disorders. Addis Ababa University School of Medicine started its Emergency Medicine Residency in 2010 and Emergency Medicine training for fourth-year medical students started in 2013. This study aims to assess attitudes of fifth year medical students towards Emergency Medicine training and its contribution to their final year of medical school training. Methods:Two hundred fifth year medical students participated in the study by convenience sampling. Self-administered questionnaires and Likert scales were used for data collection. Descriptive frequencies and chi-square analysis were done for categorical data. Ethical oversight was provided by the Institutional Review Board of the Addis Ababa University College of Health Sciences. Results:Of the 200 participants, 150 were male and 50 were female. 80% agreed its relevance for undergraduates. Relevance was significantly associated with recommendation to other medical schools (? 2 = 8.34, Pr = 0.004). 72% of respondents agreed lectures are appropriate teaching methods, 70% agreed group activity, 68.5% skill sessions, 67.5% morning discussions, 64% diagnostic session, 60% duty exposures and 45% seminars. Difficulties faced during internship are primarily attributed to lack of facilities, ranging from the setup of the emergency centre to instruments and emergency drugs. 60% of respondents agreed that Emergency Medicine training is important to future careers. 65% agreed recommending training to other medical schools. Conclusion:An Emergency Medicine rotation during the final year of medical school provides opportunities to learn about undifferentiated medical emergencies and it should be included for other medical schools in the country. Participants suggest that leadership aspects of Emergency Medicine need more emphasis as the curriculum is further developed in the future.
| S-EPMC6234139 | biostudies-literature