Promoting professionalism via a video-based educational workshop for academic hospitalists and housestaff

Distribution of internal medicine rotations among resident physicians in Japan: a nationwide, multicenter, cross-sectional study

BACKGROUND

In Japan, postgraduate clinical training encompasses a 2-year residency program, including at least 24 weeks of internal medicine (IM) rotations. However, the fragmented structure of these rotations can compromise the training's quality and depth. For example, a resident might spend only a few weeks in cardiology before moving to endocrinology, without sufficient time to deepen their understanding or have clinical experience. This study examined current patterns and lengths of IM rotations within the Japanese postgraduate medical system. It scrutinized the piecemeal approach-whereby residents may engage in multiple short-term stints across various subspecialties without an overarching, integrated experience-and explored potential consequences for their clinical education.

METHODS

This nationwide, multicenter, cross-sectional study used data from self-reported questionnaires completed by participants in the 2022 General Medicine In-Training Examination (GM-ITE). Data of 1,393 postgraduate year (PGY) one and two resident physicians who participated in the GM-ITE were included. We examined the IM rotation duration and number of IM subspecialties chosen by resident physicians during a 2-year rotation.

RESULTS

Approximately half of the participants chose IM rotation periods of 32-40 weeks. A significant proportion of participants rotated in 5-7 internal medicine departments throughout the observation period. Notable variations in the distribution of rotations were observed, characterized by a common pattern where resident physicians typically spend 4 weeks in each department before moving to the next. This 4-week rotation is incrementally repeated across different subspecialties without a longer, continuous period in any single area. Notably, 39.7% of participants did not undertake general internal medicine rotations. These results suggest a narrowed exposure to medical conditions and patient care practices.

CONCLUSIONS

Our study highlights the need to address the fragmented structure of IM rotations in Japan. We suggest that short, specialized learning periods may limit the opportunity to gain broad in-depth knowledge and practical experience. To improve the efficacy of postgraduate clinical education, we recommend fostering more sustained and comprehensive learning experiences.

Impact of general medicine rotation training on the in-training examination scores of 11, 244 Japanese resident physicians: a Nationwide multi-center cross-sectional study

BACKGROUND

Although general medicine (GM) faculty in Japanese medical schools have an important role in educating medical students, the importance of residents' rotation training in GM in postgraduate education has not been sufficiently recognized in Japan. To evaluate the relationship between the rotation of resident physicians in the GM department and their In-Training Examination score.

METHODS

This study is a nationwide multi-center cross-sectional study in Japan. Participants of this study are Japanese junior resident physicians [postgraduate year (PGY)-1 and PGY-2] who took the General Medicine In-Training Examination (GM-ITE) in fiscal years 2016 to 2018 at least once (n = 11,244). The numbers of participating hospitals in the GM-ITE were 381, 459, and 503 in 2016, 2017, and 2018.The GM-ITE score consisted of four categories (medical interview/professionalism, symptomatology/clinical reasoning, physical examination/procedure, and disease knowledge). We evaluated relationship between educational environment (including hospital information) and the GM-ITE score.

RESULTS

A total of 4464 (39.7%) residents experienced GM department rotation training. Residents who rotated had higher total scores than residents who did not rotate (38.1 ± 12.1, 36.8 ± 11.7, and 36.5 ± 11.5 for residents who experienced GM rotation training, those who did not experience this training in hospitals with a GM department, and those who did not experience GM rotation training in hospitals without a GM department, p = 0.0038). The association between GM rotation and competency remained after multivariable adjustment in the multilevel model: the score difference between GM rotation training residents and non-GM rotation residents in hospitals without a GM department was estimated as 1.18 (standard error, 0.30, p = 0.0001), which was approximately half of the standard deviation of random effects due to hospital variation (estimated as 2.00).

CONCLUSIONS

GM rotation training improved the GM-ITE score of residents and should be considered mandatory for junior residents in Japan.

Hospital characteristics preferred by medical students for their residency programs: A nationwide matching data analysis

BACKGROUND

In 2004, Japan introduced a mandatory 2-year postgraduate training program for graduating medical students with a super-rotation curriculum. A national matching system was established to determine the hospital residency programs best suited for the students. We examined the hospital characteristics preferred by applicants for residencies.

METHODS

A nationwide cross-sectional study was conducted. Data on salaries, bonuses, and number of accepted ambulances were compiled from the Residency Electronic Information System. Information on the prefectural population, urban area, and number of senior residents (postgraduate years 3-5) for specialty training was extracted from data published on the web page. The ratio of the number of first-choice applicants to recruitment capacity (matching ratio) for each program was compared between the characteristics of the hospitals and prefectures.

RESULTS

A strong linear relationship was observed between the number of first-choice applications and the allocated number of resident positions (correlation coefficient, .72). The matching ratio was greater in community hospitals (2.10 times compared with university hospitals; 95% confidence interval [CI], 1.75-2.53), in hospitals with higher numbers of accepted ambulance cases (1.05 times per 1000 annually; 95% CI, 1.03-1.08), and in hospitals that served a larger prefectural population (1.05 times per million; 95% CI, 1.02-1.08).

CONCLUSIONS

Financial incentives do not seem to attract residency applicants. Applicants prefer non-university hospitals located in populous areas and those that accept larger number of ambulance cases. To recruit junior residents, an emergency department may need to have higher activity with larger numbers and variety of cases.

Teaching Professionalism in Postgraduate Medical Education: A Systematic Review

PURPOSE

This systematic review sought to summarize published professionalism curricula in postgraduate medical education (PGME) and identify best practices for teaching professionalism.

METHOD

Three databases (MEDLINE, Embase, ERIC) were searched for articles published from 1980 through September 7, 2017. English-language articles were included if they (1) described an educational intervention addressing professionalism, (2) included postgraduate medical trainees, and (3) evaluated professionalism outcomes.

RESULTS

Of 3,383 articles identified, 50 were included in the review. The majority evaluated pre- and posttests for a single group (24, 48%). Three (6%) were randomized controlled trials. The most common teaching modality was small-group discussions (28, 56%); other methods included didactics, reflection, and simulations. Half (25, 50%) used multiple modalities. The professionalism topics most commonly addressed were professional values/behavior (42, 84%) and physician well-being (23, 46%). Most studies measured self-reported outcomes (attitude and behavior change) (27, 54%). Eight (16%) evaluated observed behavior and 3 (6%) evaluated patient outcomes. Of 35 studies that evaluated statistical significance, 20 (57%) reported statistically significant positive effects. Interventions targeting improvements in knowledge were most often effective (8/12, 67%). Curriculum duration was not associated with effectiveness. The 45 quantitative studies were of moderate quality (Medical Education Research Study Quality Instrument mean score = 10.3).

CONCLUSIONS

Many published curricula addressing professionalism in PGME are effective. Significant heterogeneity in curricular design and outcomes assessed made it difficult to synthesize results to identify best practices. Future work should build upon these curricula to improve the quality and validity of professionalism teaching tools.

Organizational Factors Contributing to Incivility at an Academic Medical Center and Systems-Based Solutions: A Qualitative Study

PURPOSE

A rise in incivility has been documented in medicine, with implications for patient care, organizational effectiveness, and costs. This study explored organizational factors that may contribute to incivility at one academic medical center and potential systems-level solutions to combat it.

METHOD

The authors completed semistructured individual interviews with full-time faculty members of the Department of Medicine (DOM) at the University of Toronto Faculty of Medicine, Toronto, Ontario, Canada, with clinical appointments at six affiliated hospitals, between June and September 2016. They asked about participants' experiences with incivility, potential contributing factors, and possible solutions. Two analysts independently coded a portion of the transcripts until a framework was developed with excellent agreement within the research team, as signified by the Kappa coefficient. A single coder completed analysis of the remaining transcripts.

RESULTS

Forty-nine interviews with physicians from all university ranks and academic position descriptions were completed. All participants had collegial relationships with colleagues but had observed, heard of, or been personally affected by uncivil behavior. Incivility occurred furtively, face-to-face, or online. The participants identified several organizational factors that bred incivility including physician nonemployee status in hospitals, silos within the DOM, poor leadership, a culture of silence, and the existence of power cliques. They offered many systems-level solutions to combat incivility through prevention, improved reporting, and clearer consequences.

CONCLUSIONS

Existing strategies to combat incivility have focused on modifying individual behavior, but opportunities may exist to reduce incivility through a greater understanding of the role of health care organizations in shaping workplace culture.

Prevention and management of unprofessional behaviour among adults in the workplace: A scoping review

BACKGROUND

Unprofessional behaviour is a challenge in academic medicine. Given that faculty are role models for trainees, it is critical to identify strategies to manage these behaviours. A scoping review was conducted to identify interventions to prevent and manage unprofessional behaviour in any workplace or professional setting.

METHODS

A search of 14 electronic databases was conducted in March 2016, reference lists of relevant systematic reviews were scanned, and grey literature was searched to identify relevant studies. Experimental and quasi-experimental studies that reported on interventions to prevent or manage unprofessional behaviours were included. Studies that reported impact on any outcome were eligible. Two reviewers independently screened articles and completed data abstraction. Qualitative analysis of the definitions of unprofessional behaviour was conducted. Data were charted to describe the study, participant, intervention and outcome characteristics.

RESULTS

12,482 citations were retrieved; 23 studies with 11,025 participants were included. The studies were 12 uncontrolled before and after studies, 6 controlled before and after studies, 2 cluster-randomised controlled trials (RCTs), 1 RCT, 1 non-randomised controlled trial and 1 quasi-RCT. Four constructs were identified in the definitions of unprofessional behaviour: verbal and/or non-verbal acts, repeated acts, power imbalance, and unwelcome behaviour. Interventions most commonly targeted individuals (22 studies, 95.7%) rather than organisations (4 studies, 17.4%). Most studies (21 studies, 91.3%) focused on increasing awareness. The most frequently targeted behaviour change was sexual harassment (4 of 7 studies).

DISCUSSION

Several interventions appear promising in addressing unprofessional behaviour. Most of the studies included single component, in-person education sessions targeting individuals and increasing awareness of unprofessional behaviour. Fewer studies targeted the institutional culture or addressed behaviour change.

Development and Evaluation of a Physician-Targeted Video to Promote HIV Screening

Introduction. Despite national recommendations, routine opt-out HIV testing has not been widely adopted by physicians. Guided by previous research on physician barriers to HIV testing, we developed a physician-targeted video to promote routine opt-out HIV screening. The objective of this study was to evaluate this video intervention. Methods. From June to July 2016, physicians in two primary care clinics completed an online survey prior to and after watching the video. Survey items assessed acceptability of the video and HIV testing knowledge, attitudes, and intention to screen. Descriptive statistics were generated to analyze data. Results. Of the 53 participants, 90% liked or strongly liked the video. Pre- to postvideo, significant improvements were seen in the knowledge of national HIV screening recommendations (45.3% to 67.9%; p = .010) and of the proportion of unaware Houstonians living with HIV (22.6% to 75.5%; p < .001). Participant beliefs about the likelihood of patients accepting HIV testing increased from 47.2% to 84.9% pre- to postvideo (p < .001). Intention to screen did not change; participants had high intentions pre- and postvideo. Conclusions. Our study found that a video is an acceptable HIV testing promotion medium for physicians. Our video improved physician HIV testing knowledge and attitudes, overcoming key barriers to HIV testing.

Impact of a Video-Based Interactive Workshop on Unprofessional Behaviors Among Internal Medicine Residents

BACKGROUND

Unprofessional behaviors undermine the hospital learning environment and the quality of patient care.

OBJECTIVE

To assess the impact of an interactive workshop on the perceptions of and self-reported participation in unprofessional behaviors.

METHODS

We conducted a pre-post survey study at 3 internal medicine residency programs. For the workshop we identified unprofessional behaviors related to on-call etiquette: "blocking" an admission, disparaging a colleague, and misrepresenting a test as urgent. Formal debriefing tools were utilized to guide the discussion. We fielded an internally developed 20-item survey on perception and participation in unprofessional behaviors prior to the workshop. An online "booster" quiz was delivered at 4 months postworkshop, and the 20-item survey was repeated at 9 months postworkshop. Results were compared to a previously published control from the same institutions, which showed that perceptions of unprofessional behavior did not change and participation in the behaviors worsened over the internship.

RESULTS

Of 237 eligible residents, 181 (76%) completed both pre- and postsurvey. Residents perceived blocking an admission and the misrepresentation of a test as urgent to be more unprofessional at a 9-month follow-up (2.0 versus 1.74 and 2.63 versus 2.28, respectively; P < .05), with no change in perception for disparaging a colleague. Participation in unprofessional behaviors did not decrease after the workshop, with the exception of misrepresenting a test as urgent (61% versus 50%, P = .019).

CONCLUSIONS

The results of this multi-site study indicate that an interactive workshop can change perception and may lower participation in some unprofessional behaviors.