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Khalili J, Jeong J, Tibbe TD, Sim MS, Yoo SM. A Novel Curriculum for Internal Medicine Residents to Care for High-Need, High-Cost Patients. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241246889. [PMID: 38617120 PMCID: PMC11015748 DOI: 10.1177/23821205241246889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 03/26/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES High-need, high-cost (HNHC) patients represent a small proportion of patients in the US, but result in disproportionately higher healthcare utilization. Teaching Internal Medicine (IM) resident trainees to provide high value care for HNHC patients is critical. We sought to improve resident attitudes and increase clinical skills associated with treating HNHC patients by creating a curriculum that leveraged the UCLA Extensivist Program, a patient-centered medical home for HNHC patients. METHODS We developed a curriculum for PGY-2 and PGY-3 IM residents centered on caring for HNHC patients over the course of 6, 4h sessions during 1 academic year. Participants completed pre- and post-intervention surveys assessing self-rated attitudes and skills associated with caring for an HNHC patient population. RESULTS Twenty-one IM residents completed the curriculum and 41 were in the control group. There were no statistically significant differences in assessed attitudes and skills, but there were trends of improvement, including a decrease in participants who agreed or strongly agreed they felt overwhelmed when seeing patients for posthospital discharge follow up (45.0% pre- to 41.7% post-intervention) and an increase in participants who agreed or strongly agreed they have the skills to successfully transition HNHC patients between inpatient and ambulatory settings (20.0% pre- to 33.3% post-intervention). Participants reported better understanding of resources available to HNHC patients, effective coordination of transitions of care, and comprehensive assessment of social determinants of health. CONCLUSION A curriculum to improve resident attitudes and skills associated with caring for HNHC patients was successfully implemented in an IM program at a large academic medical center. The curriculum may be adapted for other training programs; long-term training woven throughout training may be important to significantly improve resident education on how to care for HNHC patients.
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Affiliation(s)
- Joshua Khalili
- Division of General Internal Medicine, Department of Medicine, UCLA, Los Angeles, CA, USA
| | - Jiyeon Jeong
- Division of General Internal Medicine, Department of Medicine, UCLA, Los Angeles, CA, USA
| | - Tristan D Tibbe
- Statistics Core, Department of Medicine, UCLA, Los Angeles, CA, USA
| | - Myung-Shin Sim
- Statistics Core, Department of Medicine, UCLA, Los Angeles, CA, USA
| | - Sun M Yoo
- Division of General Internal Medicine, Department of Medicine, UCLA, Los Angeles, CA, USA
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Janerka C, Leslie GD, Gill FJ. Development of patient-centred care in acute hospital settings: A meta-narrative review. Int J Nurs Stud 2023; 140:104465. [PMID: 36857979 DOI: 10.1016/j.ijnurstu.2023.104465] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/29/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Patient-centred care is widely recognised as a core aspect of quality health care and has been integrated into policy internationally. There remains a disconnect between policy and practice, with organisations and researchers continuing to offer definitions and frameworks to suit the operational context. It is unclear if and how patient-centred care has been adopted in the acute care context. AIM To understand the development of patient-centred care in the context of acute hospital settings over the past decade. METHODS A literature review was conducted in accordance with RAMESES standards and principles for meta-narrative reviews. Five databases (Medline, CINAHL, SCOPUS, Cochrane Library, JBI) were searched for full-text articles published between 2012 and 2021 related to patient-centred care in the acute care setting, in the context of nursing, medicine and health policy. Literature reviews and discussion papers were excluded. Articles were selected based on their relevance to the research aim. Descriptive and thematic analysis and synthesis of data were undertaken via an interpretivist process to understand the development of the topic. RESULTS One hundred and twenty four articles were included that reported observational studies (n = 78), interventions (n = 34), tool development (n = 7), expert consensus (n = 2), quality improvement (n = 2), and reflection (n = 1). Most studies were conducted in developed countries and reported the perspective of patients (n = 33), nurses (n = 29), healthcare organisations (n = 7) or multiple perspectives (n = 50). Key words, key authors and organisations for patient-centred care were commonly recognised and provided a basis for the research. Fifty instruments measuring patient-centred care or its aspects were identified. Of the 34 interventions, most were implemented at the micro (clinical) level (n = 25) and appeared to improve care (n = 30). Four articles did not report outcomes. Analysis of the interventions identified three main types: i) staff-related, ii) patient and family-related, and iii) environment-related. Analysis of key findings identified five meta-narratives: i) facilitators of patient-centred care, ii) threats to patient-centred care, iii) outcomes of patient-centred care, iv) elements of patient-centred care, and v) expanding our understanding of patient-centred care. CONCLUSIONS Interest in patient centred care continues to grow, with reports shifting from conceptualising to operationalising patient-centred care. Interventions have been successfully implemented in acute care settings at the micro level, further research is needed to determine their sustainability and macro level implementation. Health services should consider staff, patient and organisational factors that can facilitate or threaten patient-centred care when planning interventions. TWEETABLE ABSTRACT Patient-centred care in acute care settings - we have arrived! Is it sustainable?
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Affiliation(s)
- Carrie Janerka
- School of Nursing, Curtin University, Western Australia, Australia; Fiona Stanley Hospital, South Metropolitan Health Service, Western Australia, Australia.
| | - Gavin D Leslie
- School of Nursing, Curtin University, Western Australia, Australia; Fiona Stanley Hospital, South Metropolitan Health Service, Western Australia, Australia
| | - Fenella J Gill
- School of Nursing, Curtin University, Western Australia, Australia; Perth Children's Hospital, Child and Adolescent Health Service, Western Australia, Australia
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Adam P, Mauksch LB, Brandenburg DL, Danner C, Ross VR. Optimal training in communication model (OPTiCOM): A programmatic roadmap. PATIENT EDUCATION AND COUNSELING 2023; 107:107573. [PMID: 36410312 DOI: 10.1016/j.pec.2022.107573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/13/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Teaching primary care residents patient communication skills is essential, complex, and impeded by barriers. We find no models guiding faculty how to train residents in the workplace that integrate necessary system components, the science of physician-patient communication training and competency-based medical education. The aim of this project is to create such a model. METHODS We created OPTiCOM using four steps: (1) communication educator interviews, analysis and theme development; (2) initial model construction; (3) model refinement using expert feedback; (4) structured literature review to validate, refine and finalize the model. RESULTS Our model contains ten interdependent building blocks organized into four developmental tiers. The Foundational value tier has one building block Naming relationship as a core value. The Expertize and resources tier includes four building blocks addressing: Curricular expertize, Curricular content, Leadership, and Time. The four building blocks in the Application and development tier are Observation form, Faculty development, Technology, and Formative assessment. The Language and culture tier identifies the final building block, Culture promoting continuous improvement in teaching communication. CONCLUSIONS OPTiCOM organizes ten interdependent systems building blocks to maximize and sustain resident learning of communication skills. Practice Implications Residency faculty can use OPTiCOM for self-assessment, program creation and revision.
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Affiliation(s)
- Patricia Adam
- Department of Family Medicine and Community Health, University of Minnesota, Smiley's Clinic, 2020 East 28th Street, Minneapolis, MN 55407, USA.
| | - Larry B Mauksch
- Emeritus - Department of Family Medicine, University of Washington, Home, 6026 30th Ave NE, Seattle, WA 98115, USA.
| | - Dana L Brandenburg
- Department of Family Medicine and Community Health, University of Minnesota, Smiley's Clinic, 2020 East 28th Street, Minneapolis, MN 55407, USA.
| | - Christine Danner
- Department of Family Medicine and Community Health, University of Minnesota, Bethesda Clinic, 580 Rice St, St Paul, MN 55103, USA.
| | - Valerie R Ross
- University of Washington Department of Family Medicine, Family Medicine Residency Program, Box 356390, 331 N.E. Thornton Place, Seattle, WA 98125, USA.
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Alomran A, Alyousefi N. Attitudes of Family Medicine Trainees Towards Patient-Centeredness Practice. Int J Gen Med 2023; 16:329-336. [PMID: 36726363 PMCID: PMC9885767 DOI: 10.2147/ijgm.s400820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/18/2023] [Indexed: 01/28/2023] Open
Abstract
Objective The interaction between physicians and patients is essential in clinical practice. Patient-centered care (PCC) is becoming popular in healthcare and provides an approach to deliver high-quality healthcare to yield positive clinical outcomes. This study explores family medicine residents' attitudes toward the physician-patient relationship and patient-centered care and the possible influence of demographic characteristics, level of training, school of graduation, and previous training. Methods A cross-sectional study was conducted among family medicine residents in Riyadh. They were invited to enroll in a web-based survey that includes demographic data, training details, and the "Patient Practitioner Orientation Scale (PPOS).". Results A total of 114 family medicine residents completed the survey. There were 68 (59.6%) males and 46 (40.4%) female residents. The overall PPOS was 4.23 ± 0.53. The mean score for sharing domain was 3.97 ± 0.66. The caring domain scored 4.49 ± 0.57. No correlations were found between the residents' demographic data and other included variables, and the means of sharing domain, caring domain, and overall score. Conclusion Family medicine residents were found to have positive attitudes toward patient-centeredness. Integrating patient-centered training early in the curriculum can improve healthcare students' and trainees' attitudes toward patient-centered care. Future research can explore the possible interventions in systematic assessment and training programs that can improve PCP.
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Affiliation(s)
- Amal Alomran
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Department of Family and Community Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia,Correspondence: Amal Alomran, Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, 11362, Saudi Arabia, Tel +966114670836, Email
| | - Nada Alyousefi
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Department of Family and Community Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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Burstein DS, Chretien KC, Puchalski C, Teufel K, Aivaz M, Kaboff A, Tuck MG. Internal Medicine Residents' Experience Performing Routine Assessment of What Matters Most to Patients Upon Hospital Admission. TEACHING AND LEARNING IN MEDICINE 2023; 35:83-94. [PMID: 35067146 DOI: 10.1080/10401334.2021.2018696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 11/24/2021] [Indexed: 06/14/2023]
Abstract
PROBLEM Failure to elicit patients' values, goals, and priorities can result in missed opportunities to provide patient-centered care. Little is known about resident physicians' direct experience of eliciting patients' values, goals, and priorities and integrating them into routine hospital care. INTERVENTION In 2017, we asked resident physicians on general internal medicine wards rotations to elicit and document a "Personal History" from patients upon hospital admission, in addition to a traditional social history. We defined a Personal History as documenting "what matters most to the patient and why." The purpose of the Personal History was to understand and consider patients' values, goals, and priorities. We then conducted qualitative interviews of the resident physicians to understand their experiences eliciting and integrating patients' values, goals, and priorities in routine hospital care. CONTEXT We performed this exploratory intervention at a large high-volume urban hospital. Two teams from general medicine wards participated in the Personal History intervention. We conducted voluntary interviews of eligible residents (n = 14/15; 93%) about their experience after they completed their general wards rotations. Using the coproduction model, our aim was to explore how patients' self-expertise can be combined with physicians' medical expertise to achieve patient-centered care. IMPACT Four major themes were identified: 1) Taking a Personal History had value, and eliciting patients' self-expertise had the potential to change medical decision making, 2) Situational and relational factors created barriers to obtaining a Personal History, 3) Variability in buy-in with the proposed intervention affected effort, and 4) Meaningful Personal History taking could be an adaptive and longitudinal process. Perceived benefits included improved rapport with patients, helpful for patients with complex medical history, and improved physician-patient communication. Barriers included patient distress, lack of rapport, and responses from patients which did not add new insights. Accountability from attending physicians affected resident effort. Suggested future applications were for patients with serious illness, integration into electronic health records, and skills taught in medical education. LESSONS LEARNED Resident physicians had generally positive views of eliciting a Personal History from patients upon admission to the hospital. Overall, many residents conveyed the perceived ability to elicit and consider patient's values, goals, and priorities in certain situations (e.g., patient not in distress, adequate rapport, lack of competing priorities such as medical emergencies or overwhelming workloads). External factors, such as electronic health record design and accountability from attending physicians, may further promote residents' efforts to routinely incorporate patients' values, goals, and priorities in clinical care. Increasing familiarity among both resident physicians and patients in routinely discussing patients' values, goals, and priorities may facilitate patient-centered practice.
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Affiliation(s)
- David S Burstein
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Katherine C Chretien
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christina Puchalski
- Department of Internal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Karolyn Teufel
- Department of Internal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Marudeen Aivaz
- General Surgery, Northwell Health, New York, New York, USA
| | - Austin Kaboff
- Internal Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Matthew G Tuck
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Veterans Affairs Medical Center, Washington, DC, USA
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Sharp M, Williams N, Tackett S, Hanyok LA, Christmas C, Rand CS, Ziegelstein RC, Record JD. Observation tool to measure patient-centered behaviors on rounds in an academic medical center. MEDICAL EDUCATION ONLINE 2022; 27:2024115. [PMID: 34994682 PMCID: PMC8745350 DOI: 10.1080/10872981.2021.2024115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/19/2021] [Accepted: 12/27/2021] [Indexed: 06/03/2023]
Abstract
OBJECTIVE As part of a quality improvement project, we developed and employed an observation checklist to measure patient-centered behaviors during daily rounds to assess the frequency of patient-centered behaviors among a patient-centered care (PCC) team and standard team (ST) rounds. PATIENTS AND METHODS On four general medicine service (GMS) teaching teams at an urban academic medical center in which housestaff rotate, we utilized an observation checklist to assess the occurrence of eight behaviors on inpatient daily rounds. The checklist covered domains of patient-centered communication, etiquette-based behaviors, and shared decision-making. One GMS team is guided by a PCC curriculum that emphasizes patient-centered communication strategies, but not specifically behaviors during bedside rounds. RESULTS Between August 2018 and May 2019 a trained observer completed 448 observations of patient rounding encounters using the checklist. Across all teams, 46.0% of the 8 behaviors were performed when possible, with more done on the PCC team (58.0%) than ST (42.0%), p < 0.01. CONCLUSIONS Performance of patient-centered behaviors during daily rounds was low overall. Despite having no specific instruction on daily rounds, patient-centered behaviors were more frequent among the teams which were part of a PCC curriculum. However, the frequency of observed behaviors was modest, suggesting that more explicit efforts to change rounding behaviors are needed. Our observational checklist may be a tool to assist in future interventions to improve patient-centered behaviors on daily rounds.
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Affiliation(s)
- Michelle Sharp
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicole Williams
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sean Tackett
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Laura A. Hanyok
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Colleen Christmas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Cynthia S. Rand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Roy C. Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Janet D. Record
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Bansal A, Greenley S, Mitchell C, Park S, Shearn K, Reeve J. Optimising planned medical education strategies to develop learners' person-centredness: A realist review. MEDICAL EDUCATION 2022; 56:489-503. [PMID: 34842290 PMCID: PMC9306905 DOI: 10.1111/medu.14707] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 05/31/2023]
Abstract
CONTEXT Person-centeredness is a stated aim for medical education; however, studies suggest this is not being achieved. There is a gap in our understanding of how, why and in what circumstances medical education interventions that aim to develop person-centredness are successful. METHODS A realist review was conducted with a search of Medline, Embase, HMIC and ERIC databases and the grey literature using the terms 'medical education' and 'person-centred' and related synonyms. Studies that involved a planned educational intervention in medical education with data on outcomes related to person-centredness were included. The analysis focused on how and why different educational strategies interact with biomedical learner perspectives to trigger mechanisms that may or may not lead to a change in perspective towards person-centredness. RESULTS Sixty-one papers representing fifty-three interventions were included in the final synthesis. Nine context-intervention-mechanism-outcome configuration (CIMOc) statements generated from the data synthesis make up our refined programme theory. Where educational interventions focused on communication skills learning or experiences without person-centred theory, learners experienced dissonance with their biomedical perspective which they resolved by minimising the importance of the learning, resulting in perspective endurance. Where educational interventions applied person-centred theory to meaningful experiences and included support for sense making, learners understood the relevance of person-centeredness and felt able to process their responses to learning, resulting in perspective transformation towards person-centredness. CONCLUSION Our findings offer explanations as to why communication skills-based interventions may be insufficient to develop learners' person-centredness. Integrating experiential person-centred learning with theory on why person-centredness matters to clinical practice and enabling learners to make sense of their responses to learning, may support perspective transformation towards person-centredness. Our findings offer programme and policymakers testable theory to inform the development of medical education strategies that aim to support person-centredness.
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Affiliation(s)
- Aarti Bansal
- Academy of Primary Care, Hull York Medical SchoolUniversity of HullHullUK
| | - Sarah Greenley
- Institute of Clinical and Applied Health ResearchUniversity of HullHullUK
| | - Caroline Mitchell
- Academic Unit of Medical EducationSam Fox House, Northern General HospitalSheffieldUK
| | - Sophie Park
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Katie Shearn
- Health and Wellbeing Research Institute – Postgraduate Research CentreSheffield Hallam UniversitySheffieldUK
| | - Joanne Reeve
- Academy of Primary Care, Hull York Medical SchoolUniversity of HullHullUK
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Alrawiai S, Asimakopoulou K, Scambler S. Patient-Centred Care in Dentistry: Definitions and Models - Commentary. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2021; 25:637-640. [PMID: 33180971 DOI: 10.1111/eje.12629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 09/25/2020] [Accepted: 10/18/2020] [Indexed: 06/11/2023]
Abstract
Patient-centred care is an important approach that is currently being adopted, to varying degrees of success, in a number of healthcare settings, particularly in family medicine and nursing. However, patient-centred care is relatively understudied in dentistry. This commentary aims to provide a general overview of patient-centred care studies conducted in dentistry, of how the approach is defined in this setting, and of the different models that have aimed to operationalize the concept. This concept is particularly relevant to dental education as current guidelines for dentists encourage and require them to adopt different dimensions of this approach. In addition to policies and guidelines, there is evidence that suggests that the adoption of patient-centred care would result in positive outcomes.
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Affiliation(s)
- Sumaiah Alrawiai
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Koula Asimakopoulou
- Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Sasha Scambler
- Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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Christmas C, Dunning K, Hanyok LA, Ziegelstein RC, Rand CS, Record JD. Effects on Physician Practice After Exposure to a Patient-Centered Care Curriculum During Residency. J Grad Med Educ 2020; 12:705-709. [PMID: 33391594 PMCID: PMC7771592 DOI: 10.4300/jgme-d-20-00067.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/13/2020] [Accepted: 08/24/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND A novel patient-centered curricular experience was implemented in an internal medicine residency program in 2007. There is little published evidence that what is taught in residency affects practice after graduation. OBJECTIVE We sought to evaluate whether graduates perceived any long-term effects of participation in this patient-centered curriculum. METHODS From July to September 2015, a web-based survey with quantitative and qualitative components was sent to graduates of the program to assess self-reported effects of this curriculum on current practice. Graduates spent 2 to 8 weeks on the intervention team during their training. Responses to open-ended questions were independently coded by 2 investigators, using the editing analysis method. Emergent themes and representative quotes are reported. RESULTS Of 150 residents who completed at least 1 year of training from 2007 to 2014, 94 of 110 (85%) with available email addresses responded to this survey. Of respondents, 21 (22%) were still in fellowship training, and 71 (76%) were in full-time practice. The majority responded "a great deal" when asked if the experience was valuable to their training as a physician (72 of 94, 77%) or influenced their practice (59 of 94, 63%). Free-text comments indicate that residents felt the experience enhanced their understanding of social determinants of health, communication skills, relationship building, and ability to tailor treatments to individual patients. CONCLUSIONS Internal medicine residency graduates reported that exposure to a curriculum focused on knowing patients as individuals had important enduring effects on their practice.
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Affiliation(s)
| | | | - Laura A Hanyok
- Faculty, Department of Medicine, Johns Hopkins School of Medicine
| | | | - Cynthia S Rand
- Faculty, Department of Medicine, Johns Hopkins School of Medicine
| | - Janet D Record
- Faculty, Department of Medicine, Johns Hopkins School of Medicine
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Hallen S. Redesigning the Clinical Learning Environment to Improve Interprofessional Care and Education: Multi-Method Program Evaluation of the iPACE Pilot Unit. J Grad Med Educ 2020; 12:598-610. [PMID: 33149830 PMCID: PMC7594784 DOI: 10.4300/jgme-d-19-00675.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/17/2020] [Accepted: 07/23/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND In 2016, Maine Medical Center received an Accreditation Council for Graduate Medical Education Pursuing Excellence in Innovation grant to redesign the clinical learning environment to promote interprofessional care and education. The Interprofessional Partnership to Advance Care and Education (iPACE) model was developed and piloted on an adult inpatient medicine unit as an attempt achieve these aims. OBJECTIVE We describe the iPACE model and associated outcomes. METHODS Surveys and focus groups were employed as part of a multimethod pragmatic observational strategy. Team surveys included relational coordination (RC): a validated proprietary measure of interpersonal communication and relationships within teams. Pre-iPACE respondents were a representative historical sample from comparable inpatient medical units surveyed from March to April 2017. iPACE respondents were model participants surveyed March to August 2018 to allow for adequate sample size. RESULTS Surveys were administered to pre-iPACE (N = 113, response rate 74%) and iPACE (N = 32, 54%) teams. Summary RC scores were significantly higher for iPACE respondents (iPACE 4.26 [SD 0.37] vs 3.72 [SD 0.44], P < .0001), and these respondents were also more likely to report a professionally rewarding experience (iPACE 4.4 [SD 0.6] vs 3.5 [SD 1.0], P < .0001). Learners felt the model was successful in teaching interprofessional best practices but were concerned it may hinder physician role development. Patient experience was positive. CONCLUSIONS This pilot may have a positive effect on team functioning and team member professional experience and patient experience. Learner acceptance may be improved by increasing autonomy and preserving traditional learning venues.
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Gross CJ, Chiel LE, Gomez AR, Marcus CH, Michelson CD, Winn AS. Defining the Essential Components of a Teaching Service. Pediatrics 2020; 146:peds.2020-0651. [PMID: 32487591 DOI: 10.1542/peds.2020-0651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES A large portion of residency education occurs in inpatient teaching services without widely accepted consensus regarding the essential components that constitute a teaching service. We sought to generate consensus around this topic, with the goal of developing criteria programs that can be used when creating, redesigning, or evaluating teaching services. METHODS A list of potential components of teaching services was developed from a literature search, interviews, and focus groups. Eighteen pediatric medical education experts participated in a modified Delphi method, responding to a series of surveys rating the importance of the proposed components. Each iterative survey was amended on the basis of the results of the previous survey. A final survey evaluating the (1) effort and (2) impact of implementing components that had reached consensus as recommended was distributed. RESULTS Each survey had 100% panelist response. Five survey rounds were conducted. Fourteen attending physician characteristics and 7 system characteristics reached consensus as essential components of a teaching service. An additional 25 items reached consensus as recommended. When evaluating the effort and impact of these items, the implementation of attending characteristics was perceived as requiring less effort than system characteristics but as having similar impact. CONCLUSIONS Consensus on the essential and recommended components of a resident teaching service was achieved by using the modified Delphi method. Although the items that reached consensus as essential are similar to those proposed by the Accreditation Council for Graduate Medical Education, those that reached consensus as recommended are less commonly discussed and should be strongly considered by institutions.
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Affiliation(s)
- Caroline J Gross
- Harvard Medical School, Harvard University and Boston Children's Hospital, Boston, Massachusetts; and .,Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Laura E Chiel
- Harvard Medical School, Harvard University and Boston Children's Hospital, Boston, Massachusetts; and
| | - Amanda R Gomez
- Harvard Medical School, Harvard University and Boston Children's Hospital, Boston, Massachusetts; and
| | - Carolyn H Marcus
- Harvard Medical School, Harvard University and Boston Children's Hospital, Boston, Massachusetts; and
| | - Catherine D Michelson
- Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Ariel S Winn
- Harvard Medical School, Harvard University and Boston Children's Hospital, Boston, Massachusetts; and
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Figueiredo AC, Leal R, Rodrigues L, Romãozinho C, Escada L, Sá H, Figueiredo A, Alves R. Arteriovenous graft in kidney transplant patients: Lookout for the rare but fearsome angiosarcoma. J Vasc Access 2019; 21:1049-1052. [PMID: 31856637 DOI: 10.1177/1129729819894468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Angiosarcomas are rare tumors, comprising less than 1% of all sarcomas. However, they portend a poor prognosis, as they tend to metastasize early, being of uttermost importance a prompt diagnosis and treatment. CASE DESCRIPTION We present the case of a 55-year-old female with history of kidney transplantation, immunosuppressed with tacrolimus, prednisolone, and mofetil mycophenolate. Fifteen years after the transplant, she developed an ulcerated lesion on the site of a nonfunctioning arteriovenous graft, which was excised. Histology was compatible with a high grade angiosarcoma that invaded the margins, and immunosuppression was switched to everolimus. Staging imaging exams revealed lymph node, muscle, and lung metastases. Shortly after, nodular lesions appeared compatible with local recurrence of the disease, and the patient showed severe deterioration of her clinical condition, being proposed for palliative chemotherapy. However, the disease showed an explosive progression and the patient died before starting the treatment. CONCLUSION This case emphasizes the importance of including inspection of the vascular access (functioning or not) in regular post-transplant consultation and value any alterations in the attempt of a timely diagnosis. Although rare, angiosarcoma is an important entity that should be considered in the differential diagnosis of soft tissue masses arising from a vascular access, especially in immunocompromised patients. Aggressive treatment should be offered whenever possible.
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Affiliation(s)
| | - Rita Leal
- Department of Nephrology, Coimbra Hospital and University Center, Coimbra, Portugal.,University Clinic of Nephrology, Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Luís Rodrigues
- Department of Nephrology, Coimbra Hospital and University Center, Coimbra, Portugal.,University Clinic of Nephrology, Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Catarina Romãozinho
- Department of Nephrology, Coimbra Hospital and University Center, Coimbra, Portugal.,University Clinic of Nephrology, Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Luís Escada
- Department of Nephrology, Coimbra Hospital and University Center, Coimbra, Portugal.,University Clinic of Nephrology, Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Helena Sá
- Department of Nephrology, Coimbra Hospital and University Center, Coimbra, Portugal.,University Clinic of Nephrology, Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Arnaldo Figueiredo
- Department of Urology and Kidney Transplantation, Coimbra Hospital and University Center, Coimbra, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Rui Alves
- Department of Nephrology, Coimbra Hospital and University Center, Coimbra, Portugal.,University Clinic of Nephrology, Faculty of Medicine, Coimbra University, Coimbra, Portugal
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Winn AS, Gross CJ, Silverman LB, Kesselheim JC. Divide and conquer: Evaluation of a redesign of a pediatric teaching service. Pediatr Blood Cancer 2019; 66:e27738. [PMID: 30924613 DOI: 10.1002/pbc.27738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/11/2019] [Accepted: 03/14/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Increasing census and work compression on the pediatric inpatient hematologic malignancy (IHM) service yielded resident dissatisfaction, impaired learning, and decreased perceived quality of patient care. This study aimed to evaluate the impact of a service redesign on resident perceptions of (a) the educational value of the rotation and (b) the safety of patient care. As a secondary objective, we evaluated the impact on the time of day of patient discharge. PROCEDURE A bundled intervention on the IHM service was instituted, including decreased patient volumes, intentional patient assignment, intentional faculty selection, and increased weekend staffing. We distributed an annual survey to end-of-the-year junior residents. We compared responses from residents who experienced the redesign (2017) with residents whose experience predated the redesign (2016). We compared the time of day of patient discharge before and after the redesign. RESULTS Survey completion rates were 70% (28/40) in 2016 and 57% (29/51) in 2017. Redesign residents rated their educational experience and perceived ability to care for patients on the nights and weekends significantly higher than previous residents. Redesign residents reported that their clinical education was compromised by excessive service less frequently than previous residents (24% vs 82%, P < 0.001). The time of day of patient discharge after the redesign was 35 minutes earlier than before the redesign (4:06 pm vs 4:41 pm, P = 0.01, 95% CI = -63, -6). CONCLUSIONS A redesign initiative of an oncology service led to improved resident perceptions of the educational value of the rotation and ability to provide safe care to patients, along with earlier discharge times.
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Affiliation(s)
- Ariel S Winn
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Caroline J Gross
- Harvard Medical School, Boston, Massachusetts.,Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Lewis B Silverman
- Harvard Medical School, Boston, Massachusetts.,Division of Pediatric Oncology, Dana-Farber Cancer Institute and Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts
| | - Jennifer C Kesselheim
- Harvard Medical School, Boston, Massachusetts.,Division of Pediatric Oncology, Dana-Farber Cancer Institute and Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts
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Chaiyachati KH, Shea JA, Asch DA, Liu M, Bellini LM, Dine CJ, Sternberg AL, Gitelman Y, Yeager AM, Asch JM, Desai SV. Assessment of Inpatient Time Allocation Among First-Year Internal Medicine Residents Using Time-Motion Observations. JAMA Intern Med 2019; 179:760-767. [PMID: 30985861 PMCID: PMC8462976 DOI: 10.1001/jamainternmed.2019.0095] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
IMPORTANCE The United States spends more than $12 billion annually on graduate medical education. Understanding how residents balance patient care and educational activities may provide insights into how the modern physician workforce is being trained. OBJECTIVE To describe how first-year internal medicine residents (interns) allocate time while working on general medicine inpatient services. DESIGN, SETTING, AND PARTICIPANTS Direct observational secondary analysis, including 6 US university-affiliated and community-based internal medicine programs in the mid-Atlantic region, of the Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education (iCOMPARE) trial, a cluster-randomized trial comparing different duty-hour policies. A total of 194 weekday shifts were observed and time motion data were collected, sampled by daytime, nighttime, and call shifts in proportion to the distribution of shifts within each program from March 10 through May 31, 2016. Data were analyzed from June 1, 2016, through January 5, 2019. MAIN OUTCOMES AND MEASURES Mean time spent in direct and indirect patient care, education, rounds, handoffs, and miscellaneous activities within a 24-hour period and in each of four 6-hour periods (morning, afternoon, evening, and night). Time spent multitasking, simultaneously engaged in combinations of direct patient care, indirect patient care, or education, and in subcategories of indirect patient care were tracked. RESULTS A total of 80 interns (55% men; mean [SD] age, 28.7 [2.3] years) were observed across 194 shifts, totaling 2173 hours. A mean (SD) of 15.9 (0.7) hours of a 24-hour period (66%) was spent in indirect patient care, mostly interactions with the patient's medical record or documentation (mean [SD], 10.3 [0.7] hours; 43%). A mean (SD) of 3.0 (0.1) hours was spent in direct patient care (13%) and 1.8 (0.3) hours in education (7%). This pattern was consistent across the 4 periods of the day. Direct patient care and education frequently occurred when interns were performing indirect patient care. Multitasking with 2 or more indirect patient care activities occurred for a mean (SD) of 3.8 (0.4) hours (16%) of the day. CONCLUSIONS AND RELEVANCE This study's findings suggest that within these US teaching programs, interns spend more time participating in indirect patient care than interacting with patients or in dedicated educational activities. These findings provide an essential baseline measure for future efforts designed to improve the workday structure and experience of internal medicine trainees, without making a judgment on the current allocation of time. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02274818.
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Affiliation(s)
- Krisda H Chaiyachati
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Judy A Shea
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - David A Asch
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Manqing Liu
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Lisa M Bellini
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - C Jessica Dine
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Alice L Sternberg
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Yevgeniy Gitelman
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Alyssa M Yeager
- Department of Medicine, Yale-New Haven Hospital, New Haven, Connecticut
| | - Jeremy M Asch
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia
| | - Sanjay V Desai
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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Wang ES, Velásquez ST, Smith CJ, Matthias TH, Schmit D, Hsu S, Leykum LK. Triaging Inpatient Admissions: an Opportunity for Resident Education. J Gen Intern Med 2019; 34:754-757. [PMID: 30993610 PMCID: PMC6502926 DOI: 10.1007/s11606-019-04882-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In the context of internal medicine, "triage" is a newly popularized term that refers to constellation of activities related to determining the most appropriate disposition plans for patients, including assessing patients for admissions into the inpatient medicine service. The physician or "triagist" plays a critical role in the transition of care from the outpatient to the inpatient settings, yet little literature exists addressing this particular transition. The importance of this set of responsibilities has evolved over time as health systems become increasingly complex to navigate for physicians and patients. With the emphasis on hospital efficiency metrics such as emergency department throughput and appropriateness of admissions, this type of systems-based thinking is a necessary skill for practicing contemporary inpatient medicine. We believe that triaging admissions is a critical transition in the care continuum and represents an entrustable professional activity that integrates skills across multiple Accreditation Council for Graduate Medical Education (ACGME) competencies that internal medicine residents must master. Specific curricular competencies that address the domains of provider, system, and patient will deliver a solid foundation to fill a gap in skills and knowledge for the triagist role in IM residency training.
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Affiliation(s)
- Emily S Wang
- Department of Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA.
- Division of General and Hospital Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Sadie Trammell Velásquez
- Department of Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of General and Hospital Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Christopher J Smith
- Division of Hospital Medicine, University of Nebraska Medicine Center, Omaha, NE, USA
| | - Tabatha H Matthias
- Division of Hospital Medicine, University of Nebraska Medicine Center, Omaha, NE, USA
| | - David Schmit
- Department of Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of General and Hospital Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Sherwin Hsu
- Department of Medicine, Olive View - University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - Luci K Leykum
- Department of Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of General and Hospital Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Ford-Gilboe M, Wathen CN, Varcoe C, Herbert C, Jackson BE, Lavoie JG, Pauly BB, Perrin NA, Smye V, Wallace B, Wong ST, Browne For The Equip Research Program AJ. How Equity-Oriented Health Care Affects Health: Key Mechanisms and Implications for Primary Health Care Practice and Policy. Milbank Q 2018; 96:635-671. [PMID: 30350420 PMCID: PMC6287068 DOI: 10.1111/1468-0009.12349] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Policy Points A consensus regarding the need to orient health systems to address inequities is emerging, with much of this discussion targeting population health interventions and indicators. We know less about applying these approaches to primary health care. This study empirically demonstrates that providing more equity‐oriented health care (EOHC) in primary health care, including trauma‐ and violence‐informed, culturally safe, and contextually tailored care, predicts improved health outcomes across time for people living in marginalizing conditions. This is achieved by enhancing patients’ comfort and confidence in their care and their own confidence in preventing and managing health problems. This promising new evidence suggests that equity‐oriented interventions at the point of care can begin to shift inequities in health outcomes for those with the greatest need.
Context Significant attention has been directed toward addressing health inequities at the population health and systems levels, yet little progress has been made in identifying approaches to reduce health inequities through clinical care, particularly in a primary health care context. Although the provision of equity‐oriented health care (EOHC) is widely assumed to lead to improvements in patients’ health outcomes, little empirical evidence supports this claim. To remedy this, we tested whether more EOHC predicts more positive patient health outcomes and identified selected mediators of this relationship. Methods Our analysis uses longitudinal data from 395 patients recruited from 4 primary health care clinics serving people living in marginalizing conditions. The participants completed 4 structured interviews composed of self‐report measures and survey questions over a 2‐year period. Using path analysis techniques, we tested a hypothesized model of the process through which patients’ perceptions of EOHC led to improvements in self‐reported health outcomes (quality of life, chronic pain disability, and posttraumatic stress [PTSD] and depressive symptoms), including particular covariates of health outcomes (age, gender, financial strain, experiences of discrimination). Findings Over a 24‐month period, higher levels of EOHC predicted greater patient comfort and confidence in the health care patients received, leading to increased confidence to prevent and manage their health problems, which, in turn, improved health outcomes (depressive symptoms, PTSD symptoms, chronic pain, and quality of life). In addition, financial strain and experiences of discrimination had significant negative effects on all health outcomes. Conclusions This study is among the first to demonstrate empirically that providing more EOHC predicts better patient health outcomes over time. At a policy level, this research supports investments in equity‐focused organizational and provider‐level processes in primary health care as a means of improving patients’ health, particularly for those living in marginalizing conditions. Whether these results are robust in different patient groups and across a broader range of health care contexts requires further study.
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Affiliation(s)
| | - C Nadine Wathen
- Arthur Labatt Family School of Nursing, University of Western Ontario.,Centre for Research and Education on Violence Against Women and Children, University of Western Ontario
| | | | - Carol Herbert
- Schulich School of Medicine and Dentistry, University of Western Ontario
| | - Beth E Jackson
- Centre for Chronic Disease and Health Equity, Public Health Agency of Canada.,Carleton University, Canada
| | - Josée G Lavoie
- Ongomiizwin-Research, Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba
| | | | | | - Victoria Smye
- Arthur Labatt Family School of Nursing, University of Western Ontario
| | - Bruce Wallace
- School of Social Work, University of Victoria, Canada
| | - Sabrina T Wong
- School of Nursing, University of British Columbia.,Centre for Health Services and Policy Research, University of British Columbia
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Nothelle SK, Christmas C, Hanyok LA. First-Year Internal Medicine Residents' Reflections on Nonmedical Home Visits to High-Risk Patients. TEACHING AND LEARNING IN MEDICINE 2018; 30:95-102. [PMID: 29220589 DOI: 10.1080/10401334.2017.1387552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PROBLEM Patients who are high utilizers of care often experience health-related challenges that are not readily visible in an office setting but paramount for residents to learn. A nonmedical home visit performed at the beginning of residency training may help residents better understand social underpinnings related to their patient's health and place subsequent care within the context of the patient's life. INTERVENTION First-year internal medicine residents completed a nonmedical home visit to an at-risk patient prior to seeing the patient in the office for his or her first medical visit. CONTEXT We performed a thematic analysis of internal medicine interns' (n = 16) written narratives on their experience of getting to know a complex patient in his or her home prior to seeing the patient for a medical visit. Narratives were written by the residents immediately following the visit and then again at the end of the intern year, to assess for lasting impact of the intervention. Residents were from an urban academic residency program in Baltimore, Maryland, USA. OUTCOME We identified four themes from the submitted narratives. Residents discussed the visit's impact on future practice, the effect of the community and support system on health, the impact on the depth of the relationship, and the visit as a source of professional fulfillment. Whereas the four themes were present at both time points, the narratives completed immediately following the visit focused more on the themes of impact of future practice and the effect of the community and support system on health. The influence of the home visit on the depth of the relationship was a more prevalent theme in the end-of-the-year narratives. LESSONS LEARNED Although there is evidence to support the utility of learners completing medical home visits, this exploratory study shows that a nonmedical home visit can be rewarding and formative for early resident physicians. Future studies could examine the patient's perspective on the experience and whether a nonmedical home visit is a valuable tool in other patient populations.
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Affiliation(s)
- Stephanie K Nothelle
- a Department of Medicine , Johns Hopkins Bayview Medical Center , Baltimore , Maryland , USA
| | - Colleen Christmas
- a Department of Medicine , Johns Hopkins Bayview Medical Center , Baltimore , Maryland , USA
| | - Laura A Hanyok
- a Department of Medicine , Johns Hopkins Bayview Medical Center , Baltimore , Maryland , USA
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Hurley EA, Harvey SA, Winch PJ, Keita M, Roter DL, Doumbia S, Diarra NH, Kennedy CE. The Role of Patient-Provider Communication in Engagement and Re-engagement in HIV Treatment in Bamako, Mali: A Qualitative Study. JOURNAL OF HEALTH COMMUNICATION 2017; 23:129-143. [PMID: 29281593 DOI: 10.1080/10810730.2017.1417513] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Mounting evidence in sub-Saharan Africa suggests poor patient-provider communication (PPC) negatively impacts patient engagement (retention in care and adherence to medication) in antiretroviral therapy (ART) programs. In Bamako, Mali, where 36% of ART patients are lost to follow-up within 12 months of initiating treatment, we aimed to define features of positive PPC according to patient values and explore the mechanisms by which these features may sustain engagement and re-engagement according to patient and provider experiences. We conducted 33 in-depth interviews and 7 focus groups with 69 patients and 17 providers in five ART clinics. Regarding sustaining engagement, participants highlighted "establishing rapport" as a foundational feature of effective PPC, but also described how "responding to emotional needs", "eliciting patient conflicts and perspective" and "partnering to mitigate conflicts" functioned to address barriers to engagement and increase connectedness to care. Patients who had disengaged felt that "communicating reacceptance" may have prompted them re-engage sooner and that tailored "partnering to mitigate conflicts" would be more effective in sustaining re-engagement than the standard adherence education providers typically offer. Optimizing provider skills related to these key PPC features may help maximize ART patient engagement, ultimately improving health outcomes and decreasing HIV transmission in sub-Saharan Africa.
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Affiliation(s)
- Emily A Hurley
- a Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
- b Health Services and Outcomes Research , Children's Mercy Hospital , Kansas City , MO , USA
| | - Steven A Harvey
- a Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Peter J Winch
- a Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Mariam Keita
- c Faculté de Medecine et d'OdontoStomatologie , Université des Sciences, des Techniques et des Technologies de Bamako , Bamako , Mali
| | - Debra L Roter
- d Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Seydou Doumbia
- c Faculté de Medecine et d'OdontoStomatologie , Université des Sciences, des Techniques et des Technologies de Bamako , Bamako , Mali
| | - Nièlè H Diarra
- c Faculté de Medecine et d'OdontoStomatologie , Université des Sciences, des Techniques et des Technologies de Bamako , Bamako , Mali
| | - Caitlin E Kennedy
- a Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Abstract
Current ACGME regulations have limited residents' weekly hours and continuous working hours, a marked change, despite its uncertain effects on physician well-being and quality of care. Although residency programs in internal medicine and family medicine have adapted schedules to conform to these regulations, increasing evidence is accumulating to suggest that these training experiences are not adequately preparing the next generation of practicing primary care and hospital-based physicians. Data from an array of sources continue to demonstrate significant deficiencies in six areas of residents' responsibilities towards their patients: diminished patient "face time" and direct patient care; focus on patients' "reason for hospitalization" or "reason for visit" at the expense of possible neglect of patients' "secondary" medical problems; limited attention to patients' emotional or contextual problems and limited empathy; deficient implementation of the essential constituents of patient-centered care; neglect of habitual "reflective practice"; and excessive distinction between inpatient and outpatient responsibilities, leading to missed opportunities for inpatient residents to be aware of and attend to patients' post-discharge course although new information and readmissions related to the index hospitalization are prevalent. Thus, redesigning residency programs to widen residents' outlook and cover these inseparable components of high-quality care, may infuse the often fatigued and burnt-out residents with purpose and fulfillment, finally incorporating the missing elements of patient-centered care as integral parts of patients' admissions and therefore, of physicians' future careers.
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Affiliation(s)
- Ami Schattner
- a The Faculty of Medicine , Hadassah Medical School, Hebrew University , Jerusalem , Israel
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Turchi RM, Narayan A, Esquivel M, Serwint JR. Needs Assessment for a Medical Home Curriculum for Pediatric Residents. Glob Pediatr Health 2017; 4:2333794X17740301. [PMID: 29164176 PMCID: PMC5682582 DOI: 10.1177/2333794x17740301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/09/2017] [Indexed: 11/16/2022] Open
Abstract
Several studies and the Accreditation Council for Graduate Medical Education recommend integration of medical home (MH) concepts into pediatric resident training. There is a paucity of research depicting the current landscape of pediatric resident MH education. We hypothesized formal MH curricula in pediatric residency education are limited and pediatric residency programs desire incorporating MH education into curricula. A national needs assessment of pediatric residency programs was conducted assessing inclusion of MH concepts in training. Outcomes assessed were perceived importance of including MH concepts, satisfaction of current curriculum, content taught, resources available, and barriers encountered. Fifty-six programs (28%) completed the survey, majority academic programs. Nearly 75% indicated interest in incorporating MH concepts. Fifty-one percent of programs reported faculty knowledgeable in MH concepts/implementation and 11% reported access to readily available resources. Barriers included resident schedules, faculty teaching time, funding, and not faculty priority. Pediatric program directors report interest and need for improved MH training but identify implementation barriers.
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Affiliation(s)
- Renee M. Turchi
- St. Christopher’s Hospital for Children, Philadelphia, PA, USA
- Drexel University School of Public Health, Philadelphia, PA, USA
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Chang C, Callahan EH, Hung WW, Thomas DC, Leipzig RM, DeCherrie LV. A model for integrating the assessment and management of geriatric syndromes into internal medicine continuity practice: 5-year report. GERONTOLOGY & GERIATRICS EDUCATION 2017; 38:271-282. [PMID: 26156253 DOI: 10.1080/02701960.2015.1031897] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A geriatric ambulatory curriculum was created to improve internal medicine residents' care of geriatric patients. Second-year residents met for a 3-hour session weekly for 4 consecutive weeks during a block rotation with faculty geriatricians for a curriculum focused on dementia, falls, and urinary incontinence. After a 1-hour case-based didactic session, residents applied learned content and concepts to patient consultations. Consultative encounters were precepted by faculty and shared with the team. After completing our curriculum, residents reported knowledge acquired and enhanced evaluation and management skills of these three syndromes and were more likely to use all recommended screening tests in future practice. This article describes the process and strategies guiding development of a successful ambulatory geriatric curriculum model that can be embedded into preexisting internal medicine clinics to help future internists to better manage these and other common geriatric syndromes.
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Affiliation(s)
- Christine Chang
- a Department of Geriatrics and Palliative Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
- b Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | - Eileen H Callahan
- a Department of Geriatrics and Palliative Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
- b Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | - William W Hung
- c Geriatric Research , Education and Clinical Center, James J. Peters VA Medical Center , Bronx , New York , USA
| | - David C Thomas
- b Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | - Rosanne M Leipzig
- a Department of Geriatrics and Palliative Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
- b Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | - Linda V DeCherrie
- a Department of Geriatrics and Palliative Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
- b Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
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Choi Y, Kim D, Chong H, Mallow C, Bill J, Fojo AT, Blanchard M. Use of a 90-Minute Admission Window and Front-Fill System to Reduce Work Compression on a General Medicine Inpatient Teaching Service. J Grad Med Educ 2017; 9:245-249. [PMID: 28439362 PMCID: PMC5398156 DOI: 10.4300/jgme-d-16-00211.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 10/20/2016] [Accepted: 12/05/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Duty hour limits have shortened intern shifts without concurrent reductions in workload, creating work compression. Multiple admissions during shortened shifts can result in poor training experience and patient care. OBJECTIVE To relieve work compression, improve resident satisfaction, and improve duty hour compliance in an academic internal medicine program. METHODS In 2014, interns on general ward services were allotted 90 minutes per admission from 3 pm to 7 pm, when the rate of admissions was high. Additional admissions arriving during the protected period were directed to hospitalists. Resident teams received 2 patients admitted by the night float team to start the call day (front-fill). RESULTS Of the 51 residents surveyed before and after the implementation of the intervention, 39 (77%) completed both surveys. Respondents reporting an unmanageable workload fell from 14 to 1 (P < .001), and the number of residents reporting that they felt unable to admit patients in a timely manner decreased from 14 to 2 (P < .001). Reports of adequate time with patients increased from 16 to 36 (P < .001), and residents indicating that they had time to learn from patients increased from 19 to 35 (P < .001). Reports of leaving on time after call days rose from 12 to 33 (P < .01), and overall satisfaction increased from 26 to 35 (P = .002). Results were similar when residents were resurveyed 6 months after the intervention. CONCLUSIONS Call day modifications improved resident perceptions of their workload and time for resident learning and patient care.
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Bennett NL, Flesch JD, Cronholm P, Reilly JB, Ende J. Bringing Rounds Back to the Patient: A One-Year Evaluation of the Chiefs' Service Model for Inpatient Teaching. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:528-536. [PMID: 28351066 DOI: 10.1097/acm.0000000000001459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE The Chiefs' Service (CS), a structured approach to inpatient teaching rounds, focuses on resident education and patient-centered care without disrupting patient census sizes or admitting cycles. It has five key elements: morning huddles; bedside rounds; diagnostic "time-outs"; day-of-discharge rounds; and postdischarge follow-up rounds. The authors hypothesized the CS model would be well received by residents and considered more effective than more-traditional rounds. METHOD The CS was implemented on Penn Presbyterian Medical Center's general medicine inpatient service using a quasi-experimental design. Its first year (January 2013-January 2014) was evaluated with a mixed-methods approach. Residents completed end-of-rotation evaluation questionnaires; 20 CS and 10 traditional service (TS) residents were interviewed. Measures of resident agreement on questionnaire items were compared across groups using independent sample t testing. A modified grounded theory approach was used to assess CS residents' perspectives on the CS elements and identify emergent themes. RESULTS The questionnaires were completed by 183/188 residents (response rate 97%). Compared with TS residents, CS residents reported significantly greater satisfaction in the domains of resident education and patient care, and they rated the overall value of the rotation significantly higher. The majority of CS residents found the CS elements to be effective. CS residents described the CS as focused on resident education, patient-centered care, and collaboration with an interdisciplinary team. CONCLUSIONS The CS approach to inpatient rounding is seen by residents as valuable and is associated with positive outcomes in terms of residents' perceptions of learning, interdisciplinary communication, and patient care.
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Affiliation(s)
- Nadia L Bennett
- N.L. Bennett is codirector, Internal Medicine Clerkship, and assistant professor of clinical medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.J.D. Flesch is associate program director, Internal Medicine Residency, and assistant professor of clinical medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.P. Cronholm is associate professor of family medicine and community health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.J.B. Reilly is internal medicine residency program director, Allegheny Health Network, Pittsburgh, Pennsylvania, and assistant professor of medicine, Temple University School of Medicine, Philadelphia, Pennsylvania.J. Ende is Schaeffer Professor of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Oladeru OA, Hamadu M, Cleary PD, Hittelman AB, Bulsara KR, Laurans MS, DiCapua DB, Marcolini EG, Moeller JJ, Khokhar B, Hodge JW, Fortin AH, Hafler JP, Bennick MC, Hwang DY. House staff communication training and patient experience scores. J Patient Exp 2017; 4:28-36. [PMID: 28393108 PMCID: PMC5381927 DOI: 10.1177/2374373517694533] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To assess whether communication training for house staff via role-playing exercises (1) is well received and (2) improves patient experience scores in house staff clinics. Methods: We conducted a pre–post study in which the house staff for 3 adult hospital departments participated in communication training led by trained faculty in small groups. Sessions centered on a published 5-step strategy for opening patient-centered interviews using department-specific role-playing exercises. House staff completed posttraining questionnaires. For 1 month prior to and 1 month following the training, patients in the house staff clinics completed surveys with Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) questions regarding physician communication, immediately following clinic visits. Preintervention and postintervention results for top-box scores were compared. Results: Forty-four of a possible 45 house staff (97.8%) participated, with 31 (70.5%) indicating that the role-playing exercise increased their perception of the 5-step strategy. No differences in patient responses to CG-CAHPS questions were seen when comparing 63 preintervention surveys to 77 postintervention surveys. Conclusion: Demonstrating an improvement in standard patient experience surveys in resident clinics may require ongoing communication coaching and investigation of the “hidden curriculum” of training.
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Affiliation(s)
| | | | - Paul D Cleary
- Yale School of Public Health, New Haven CT 06520, USA
| | - Adam B Hittelman
- Department of Urology, Yale School of Medicine, New Haven, CT 06520, USA; Yale-New Haven Hospital, 20 York Street, New Haven, CT 06510, USA
| | - Ketan R Bulsara
- Yale-New Haven Hospital, 20 York Street, New Haven, CT 06510, USA; Department of Neurosurgery, Yale School of Medicine, New Haven, CT 06520, USA
| | - Maxwell Sh Laurans
- Yale-New Haven Hospital, 20 York Street, New Haven, CT 06510, USA; Department of Neurosurgery, Yale School of Medicine, New Haven, CT 06520, USA
| | - Daniel B DiCapua
- Yale-New Haven Hospital, 20 York Street, New Haven, CT 06510, USA; Department of Neurology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Evie G Marcolini
- Yale-New Haven Hospital, 20 York Street, New Haven, CT 06510, USA; Department of Neurology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Jeremy J Moeller
- Yale-New Haven Hospital, 20 York Street, New Haven, CT 06510, USA; Department of Neurology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Babar Khokhar
- Yale-New Haven Hospital, 20 York Street, New Haven, CT 06510, USA; Department of Neurology, Yale School of Medicine, New Haven, CT 06520, USA
| | | | - Auguste H Fortin
- Yale-New Haven Hospital, 20 York Street, New Haven, CT 06510, USA; Department of Internal Medicine, Yale School of Medicine, CT 06520, USA
| | - Janet P Hafler
- Teaching and Learning Center, Yale School of Medicine, New Haven, CT 06520, USA
| | - Michael C Bennick
- Yale-New Haven Hospital, 20 York Street, New Haven, CT 06510, USA; Department of Internal Medicine, Yale School of Medicine, CT 06520, USA
| | - David Y Hwang
- Yale-New Haven Hospital, 20 York Street, New Haven, CT 06510, USA; Department of Neurology, Yale School of Medicine, New Haven, CT 06520, USA
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ZIEGELSTEIN ROYC. Personomics and Precision Medicine. TRANSACTIONS OF THE AMERICAN CLINICAL AND CLIMATOLOGICAL ASSOCIATION 2017; 128:160-168. [PMID: 28790500 PMCID: PMC5525386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The importance of knowing patients as individuals has been highlighted throughout the history of medicine. However, shorter visits, electronic documentation, reliance on technology, and increasing linguistic and cultural differences between patients and physicians create more challenges to effective communication than ever before. Perhaps more concerning is the greater emphasis on aspects of care considered more precisely measurable and quantifiable, the sum of which is sometimes felt to represent the patient better than knowledge of the patient himself. While genomics, proteomics, pharmacogenomics, metabolomics, and epigenomics promise enhanced diagnostics and therapeutics, understanding the unique circumstances of the person - what may be called personomics - is at least as critical to patient care. Such an understanding can only be developed when the relevant psychological, social, cultural, behavioral, and economic factors are obtained. Personomics determines how a disease reveals itself phenotypically and the way that disease and the individual with the disease respond to treatment.
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Affiliation(s)
- ROY C. ZIEGELSTEIN
- Correspondence and reprint requests: Roy C. Ziegelstein, MD, MACP,
Johns Hopkins University School of Medicine, Miller Research Building, 733 N. Broadway, Suite 115, Baltimore, Maryland 21205410-955-8651
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Khan A, Baird J, Rogers JE, Furtak SL, Williams KA, Allair B, Litterer KP, Sharma M, Smith A, Schuster MA, Landrigan CP. Parent and Provider Experience and Shared Understanding After a Family-Centered Nighttime Communication Intervention. Acad Pediatr 2017; 17:389-402. [PMID: 28143793 PMCID: PMC5438159 DOI: 10.1016/j.acap.2017.01.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/13/2017] [Accepted: 01/22/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess parent and provider experience and shared understanding after a family-centered, multidisciplinary nighttime communication intervention (nurse-physician brief, family huddle, family update sheet). METHODS We performed a prospective intervention study at a children's hospital from May 2013 to October 2013 (preintervention period) and May 2014 to October 2014 (postintervention period). Participants included 464 parents, 176 nurses, and 52 resident physicians of 582 hospitalized 0- to 17-year-old patients. Pre- versus postintervention, we compared parent/provider top-box scores (eg, "excellent") for experience with communication across several domains; and level of agreement (shared understanding) between parent, nurse, and resident reports of patients' reason for admission, overnight medical plan, and overall medical plan, as rated independently by blinded clinician reviewers (agreement = 74.7%, kappa = .60). RESULTS Top-box parent experience improved for 1 of 4 domains: Experience and Communication With Nighttime Doctors (23.6% to 31.5%). Top-box provider experience improved for all 3 domains, including Communication and Shared Understanding With Families (resident rated, 16.5% to 35.1%; nurse rated, 32.2% to 37.9%) and Experience, Communication, and Shared Understanding With Other Providers (resident rated, 20.3% to 35.0%; nurse rated, 14.7% to 21.5%). Independently rated shared understanding remained unchanged for most domains but improved for parent-nurse composite shared understanding (summed agreement for reason for admission, overall plan, and overnight plan; 36.2% to 48.2%) and nurse-resident shared understanding regarding reason for admission (67.1% to 71.2%) and regarding overall medical plan (45.0% to 58.6%). All P <.05. CONCLUSIONS A family-centered, multidisciplinary nighttime communication intervention was associated with improvements in some, but not all, domains of parent/provider experience and shared understanding, particularly provider experience and nurse-family shared understanding. The intervention was promising but requires further refinement.
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Affiliation(s)
- Alisa Khan
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
| | | | - Jayne E. Rogers
- Department of Nursing, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115
| | - Stephannie L. Furtak
- Division of General Pediatrics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115
| | - Kathryn A. Williams
- Clinical Research Center, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02215
| | - Brenda Allair
- Family Advisory Council, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115
| | - Katherine P. Litterer
- Center for Families, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115
| | | | - Alla Smith
- Division of General Pediatrics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115
| | - Mark A. Schuster
- Division of General Pediatrics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Christopher P. Landrigan
- Division of General Pediatrics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115; Department of Pediatrics, Harvard Medical School, Boston, MA; Division of Sleep Medicine, Brigham and Women's Hospital, Boston, MA
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Implementation of 2011 Duty Hours Regulations through a Workload Reduction Strategy and Impact on Residency Training. J Gen Intern Med 2016; 31:1475-1481. [PMID: 27514539 PMCID: PMC5130957 DOI: 10.1007/s11606-016-3840-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/19/2016] [Accepted: 07/27/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Training programs have implemented the 2011 ACGME duty hour regulations (DHR) using "workload compression" (WLC) strategies, attempting to fit similar clinical responsibilities into fewer working hours, or workload reduction (WLR) approaches, reducing the number of patient encounters per trainee. Many have expressed concern that these strategies could negatively impact patient care and learner outcomes. OBJECTIVE This study evaluates the medical knowledge and clinical impact of a WLR intervention in a single institution. DESIGN & PARTICIPANTS Nonrandomized intervention study with comparison to a historical control study among 58 PGY-1 internal medicine trainees in the 2 years after duty hour implementation [exposure cohort (EC), 7/1/2011-6/30/2013], compared to 2 years before implementation [comparison cohort (CC), 7/1/2009-6/30/2011]. MAIN MEASURES Process outcomes were average inpatient encounters, average new inpatient admissions, and average scheduled outpatient encounters per PGY-1 year. Performance outcomes included trainee inpatient and outpatient days on service, In-Training Examination (ITE) scores as an objective surrogate of medical knowledge, Case-Mix Index (CMI), and quality of care measures (30-day readmission rate, 30-day mortality rate, and average length of stay). KEY RESULTS Baseline characteristics and average numbers of inpatient encounters per PGY-1 class were similar between the EC and CC. However, the EC experienced fewer new inpatient admissions (157.47 ± 40.47 vs. 181.72 ± 25.45; p < 0.01), more outpatient encounters (64.80 ± 10.85 vs. 56.98 ± 6.59; p < 0.01), and had similar ITE percentiles (p = 0.58). Patients of similar complexity cared for by the EC also had a greater reduction in readmissions (21.21 % to 19.08 %; p < 0.01) than the hospital baseline (12.07 to 11.14 %; p < 0.01). CONCLUSIONS Our WLR resulted in a small decrease in the average number of new inpatient admissions and an increase in outpatient encounters. ITE and care quality outcomes were maintained or improved. While there is theoretical concern that reducing PGY-1 inpatient admissions volumes may negatively impact education and clinical care measures, this study found no evidence of such a trade-off.
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Teaching Principles of Patient-Centered Care During Radiology Residency. Acad Radiol 2016; 23:802-9. [PMID: 27067602 DOI: 10.1016/j.acra.2016.01.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 01/21/2016] [Accepted: 01/23/2016] [Indexed: 10/22/2022]
Abstract
RATIONALE AND OBJECTIVES Patient-centered healthcare delivery has become increasingly established as a cornerstone of quality medical care, but teaching these principles in a radiology residency setting is often difficult and ineffective in a traditional lecture format. We developed a novel educational session in which actual patient letters about a healthcare provider are used to facilitate a case-based discussion of key principles of patient-centered care. MATERIALS AND METHODS A novel patient letter-facilitated, case-based session was conducted at two different university-based teaching institutions. Prior to the educational session, patient letters introducing the principles of patient-centered care were distributed to residents for review. During the session, radiology-specific cases were discussed in the context of the principles introduced by the letters. A post-session survey was administered to evaluate the efficacy and usefulness of the session. RESULTS Forty-six of the 61 session attendees (75%) completed the post session survey. Most respondents (93%) preferred this case-based, interactive session to a typical didactic session. A majority of the residents indicated that both the patient letters (64%) and radiology specific cases (73%) helped them think differently about how they interact with patients. They indicated that the session enhanced their understanding of professionalism (3.7 out of 5.0 [95% CI 3.4-4.0]) and increased their motivation to become more patient-centered (3.0 out of 4.0 [95% CI 2.8-3.3]). CONCLUSIONS Our findings suggest that patient letter-facilitated, case-based sessions may influence resident attitudes regarding the principles of patient-centered care and may help to increase resident motivation to become more patient-centered in their own practice.
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Kamal AH, Anderson WG, Boss RD, Brody AA, Campbell TC, Creutzfeldt CJ, Hurd CJ, Kinderman AL, Lindenberger EC, Reinke LF. The Cambia Sojourns Scholars Leadership Program: Project Summaries from the Inaugural Scholar Cohort. J Palliat Med 2016; 19:591-600. [DOI: 10.1089/jpm.2016.0086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Renee D. Boss
- Johns Hopkins School of Medicine, Baltimore, Maryland
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Lafreniere JP, Rios R, Packer H, Ghazarian S, Wright SM, Levine RB. Burned Out at the Bedside: Patient Perceptions of Physician Burnout in an Internal Medicine Resident Continuity Clinic. J Gen Intern Med 2016; 31:203-208. [PMID: 26340808 PMCID: PMC4720641 DOI: 10.1007/s11606-015-3503-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 07/14/2014] [Accepted: 07/21/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Burnout is high among resident physicians and may be associated with suboptimal patient care and reduced empathy. OBJECTIVE To investigate the relationship between patient perceptions of empathy and enablement and physician burnout in internal medicine residents. DESIGN Cross-sectional, survey-based observational study between December 2012 and March 2013 in a resident continuity clinic located within a large urban academic primary care practice in Baltimore, Maryland. PARTICIPANTS Study participants were 44 PGY1-3 residents and a convenience sample of their English-speaking adult primary care patients (N = 244). MAIN MEASURES Patients rated their resident physicians using the Consultation and Relational Empathy Measure (CARE) and the Patient Enablement Instrument (PEI). Residents completed the Maslach Burnout Inventory (MBI). We tested for associations between resident burnout and patients' perceptions of resident empathy (CARE) and enablement (PEI) using multilevel regression analysis. KEY RESULTS Multilevel regression analyses indicated significant positive associations between physician depersonalization scores on the MBI and patient ratings of empathy (B = 0.28, SE = 0.17, p < 0.001) and enablement (B = 0.11, SE = 0.11, p = 0.02). Emotional exhaustion scores on the MBI were not significantly related to either patient outcome. CONCLUSIONS Patients perceived residents who reported higher levels of depersonalization as more empathic and enabling during their patient care encounters. The relationship between physician distress and patient perceptions of care has important implications for medical education and requires further study.
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Affiliation(s)
- Justin P Lafreniere
- Division of General Internal Medicine, Department of Medicine, Naval Medical Center Portsmouth, Portsmouth, VA, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, MD, USA
| | - Rebeca Rios
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Hillary Packer
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Sharon Ghazarian
- Department of Pediatrics, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Scott M Wright
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Rachel B Levine
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
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Maatouk-Bürmann B, Ringel N, Spang J, Weiss C, Möltner A, Riemann U, Langewitz W, Schultz JH, Jünger J. Improving patient-centered communication: Results of a randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2016; 99:117-24. [PMID: 26490488 DOI: 10.1016/j.pec.2015.08.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 08/06/2015] [Accepted: 08/07/2015] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Patient-centered communication is a key element for improving the quality of care in terms of therapeutic relationship, patient participation, and treatment process. Postgraduate trainings provide an essential way of promoting patient centeredness on the job where learning opportunities are often limited by time, patient volume, and economic pressure. In the present study, changes in patient centeredness during clinical routines of postgraduate physicians (internal medicine) after a three-day communication training were assessed. METHODS A randomized controlled trial was conducted in a primary care clinic. The intervention consisted of a communication training that aimed to enhance patient centeredness in postgraduate physicians. The training was based on a need assessment and the principles of deliberate practice. Workplace-based assessment of physicians' communication behavior was obtained using the Roter Interaction Analysis System. RESULTS Three months after the intervention, trained physicians showed significantly increased patient centeredness (F=5.36, p=.04; d=0.42). CONCLUSION The communication training significantly improved patient centeredness during routine clinical practice. Thus, this training provides a structured and theory-based concept to foster patient centeredness. PRACTICE IMPLICATIONS The results support the implementation of communication trainings as a part of faculty development and medical specialization training.
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Affiliation(s)
- Barbara Maatouk-Bürmann
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany.
| | - Nadja Ringel
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
| | - Jochen Spang
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
| | - Carmen Weiss
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Möltner
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
| | - Urs Riemann
- Department of Internal Medicine I, SLK Clinic Heilbronn, Germany
| | - Wolf Langewitz
- Division of Psychosomatic Medicine, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Jobst-Hendrik Schultz
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
| | - Jana Jünger
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
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Ziegelstein RC. Who will deliver personalized medicine? J Eval Clin Pract 2015; 21:1038-9. [PMID: 26290319 DOI: 10.1111/jep.12440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Roy C Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Feldman AM. Undergraduate medical education in the U.S. and Israel: contrasts and common challenges. Isr J Health Policy Res 2015; 4:56. [PMID: 26568820 PMCID: PMC4644288 DOI: 10.1186/s13584-015-0053-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 11/06/2015] [Indexed: 11/10/2022] Open
Abstract
In 2014, the Israeli Council for Higher Education (CHE) commissioned an international panel of outstanding educators to prepare an ad hoc report reviewing the four established medical schools in Israel. The report described the strengths, weaknesses and challenges facing medical education in Israel with a focus on three specific areas: workforce planning, the structure of the curriculum and the financing of medical education. There are interesting parallels between the challenges facing medical education in the U.S. and in Israel: a lack of clarity regarding the optimal size for the workforce and the optimal method for enhancing the number of primary care physicians; an absence of methodologies for evaluating innovations in medical education and a lack of transparency in funds flow. However, there are also important differences, one of the most important being an absence in Israel of students' hands-on responsibility for their patients until year six of their undergraduate medical education. The presence of a small number of medical schools with common funding and geographic proximity, in a relative sense, provides the Israeli medical schools with a unique opportunity to evaluate innovations in medical education and to set a high bar for inter-school collaboration and cooperation.
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Affiliation(s)
- Arthur M Feldman
- Temple University School of Medicine, 3500 N. Broad Street, Suite 1150, Philadelphia, 19107 PA USA
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Promising Practices for Achieving Patient-centered Hospital Care: A National Study of High-performing US Hospitals. Med Care 2015; 53:758-67. [PMID: 26147867 DOI: 10.1097/mlr.0000000000000396] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient-centered care is integral to health care quality, yet little is known regarding how to achieve patient-centeredness in the hospital setting. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey measures patients' reports on clinician behaviors deemed by patients as key to a high-quality hospitalization experience. OBJECTIVES We conducted a national study of hospitals that achieved the highest performance on HCAHPS to identify promising practices for improving patient-centeredness, common challenges met, and how those were addressed. RESEARCH DESIGN We identified hospitals that achieved the top ranks or remarkable recent improvements on HCAHPS and surveyed key informants at these hospitals. Using quantitative and qualitative methods, we described the interventions used at these hospitals and developed an explanatory model for achieving patient-centeredness in hospital care. RESULTS Fifty-two hospitals participated in this study. Hospitals used similar interventions that focused on improving responsiveness to patient needs, the discharge experience, and patient-clinician interactions. To improve responsiveness, hospitals used proactive nursing rounds (reported at 83% of hospitals) and executive/leader rounds (62%); for the discharge experience, multidisciplinary rounds (56%), postdischarge calls (54%), and discharge folders (52%) were utilized; for clinician-patient interactions, hospitals promoted specific desired behaviors (65%) and set behavioral standards (60%) for which employees were held accountable. Similar strategies were also used to achieve successful intervention implementation including HCAHPS data feedback, and employee and leader engagement and accountability. CONCLUSIONS High-performing hospitals used a set of patient-centered care processes that involved both leaders and clinicians in ensuring that patient needs and preferences are addressed.
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Record JD, Niranjan-Azadi A, Christmas C, Hanyok LA, Rand CS, Hellmann DB, Ziegelstein RC. Telephone calls to patients after discharge from the hospital: an important part of transitions of care. MEDICAL EDUCATION ONLINE 2015; 20:26701. [PMID: 25933623 PMCID: PMC4417079 DOI: 10.3402/meo.v20.26701] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 02/18/2015] [Accepted: 03/27/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Teaching interns patient-centered communication skills, including making structured telephone calls to patients following discharge, may improve transitions of care. OBJECTIVE To explore associations between a patient-centered care (PCC) curriculum and patients' perspectives of the quality of transitional care. METHODS We implemented a novel PCC curriculum on one of four inpatient general medicine resident teaching teams in which interns make post-discharge telephone calls to patients, contact outpatient providers, perform medication adherence reviews, and engage in patient-centered discharge planning. Between July and November of 2011, we conducted telephone surveys of patients from all four teaching teams within 30 days of discharge. In addition to asking if patients received a call from their hospital physician (intern), we administered the 3-Item Care Transitions Measure (CTM-3), which assesses patients' perceptions of preparedness for the transition from hospital to home (possible score range 0-100). RESULTS The CTM-3 scores (mean±SD) of PCC team patients and standard team patients were not significantly different (82.4±17.3 vs. 79.6±17.6, p=0.53). However, regardless of team assignment, patients who reported receiving a post-discharge telephone call had significantly higher CTM-3 scores than those who did not (84.7±16.0 vs. 78.2±17.4, p=0.03). Interns exposed to the PCC curriculum called their patients after discharge more often than interns never exposed (OR=2.78, 95% CI [1.25, 6.18], p=0.013). CONCLUSIONS The post-discharge telephone call, one element of PCC, was associated with higher CTM-3 scores--which, in turn, have been shown to lessen patients' risk of emergency department visits within 30 days of discharge.
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Affiliation(s)
- Janet D Record
- Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA;
| | - Ashwini Niranjan-Azadi
- Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Colleen Christmas
- Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laura A Hanyok
- Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cynthia S Rand
- Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David B Hellmann
- Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roy C Ziegelstein
- Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Abdulrahman M, Qayed KI, AlHammadi HH, Julfar A, Griffiths JL, Carrick FR. Challenges Facing Medical Residents' Satisfaction in the Middle East: A Report From United Arab Emirates. TEACHING AND LEARNING IN MEDICINE 2015; 27:387-394. [PMID: 26507996 DOI: 10.1080/10401334.2015.1077125] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED PHENOMENON: Medical residents' satisfaction with the quality of training for medical residency training specialists is one of the core measures of training program success. It will also therefore contribute to the integrity of healthcare in the long run. Yet there is a paucity of research describing medical residents' satisfaction in the Middle East, and there are no published studies that measure the satisfaction of medical residents trained within the United Arab Emirates (UAE). This makes it difficult to develop a quality residency training program that might meet the needs of both physicians and society. APPROACH The authors designed a questionnaire to assess medical residents' satisfaction with the Dubai residency training program in order to identify insufficiencies in the training, clinical, and educational aspects. The survey was a self-report questionnaire composed of different subscales covering sociodemographic and educational/academic profile of the residents along with their overall satisfaction of their training, curriculum, work environment, peer teamwork, and their personal opinion on their medical career. FINDINGS Respondents showed a substantial level of satisfaction with the residency training. The vast majority of residents (80%, N = 88) believe that their residency program curriculum and rotation was "good," "very good," or "excellent." Areas of dissatisfaction included salary, excessive paperwork during rotations, and harassment. INSIGHTS: This is the first report that studies the satisfaction of medical residents in all specialties in Dubai, UAE. Our findings provide preliminary evidence on the efficiency of different modifications applied to the residency program in UAE. To our knowledge, there has not been any previous study in the Middle East that has analyzed this aspect of medical residents from different specialties. The authors believe that this report can be used as a baseline to monitor the effectiveness of interventions applied in the future toward improving residency training programs in this region.
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Affiliation(s)
- Mahera Abdulrahman
- a Department of Medical Education , Dubai Health Authority , Dubai , United Arab Emirates
| | - Khalil I Qayed
- b Department of Medical Education , Ministry of Health , Dubai , United Arab Emirates
| | - Hisham H AlHammadi
- c Clinical Affairs, Dubai Healthcare City Authority , Dubai , United Arab Emirates
| | - Adnan Julfar
- a Department of Medical Education , Dubai Health Authority , Dubai , United Arab Emirates
| | - Jane L Griffiths
- a Department of Medical Education , Dubai Health Authority , Dubai , United Arab Emirates
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Aboumatar H, Allison RD, Feldman L, Woods K, Thomas P, Wiener C. Focus on Transitions of Care. Am J Med Qual 2013; 29:522-9. [DOI: 10.1177/1062860613507330] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Roshetsky LM, Coltri A, Flores A, Vekhter B, Humphrey HJ, Meltzer DO, Arora VM. No time for teaching? Inpatient attending physicians' workload and teaching before and after the implementation of the 2003 duty hours regulations. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2013; 88:1293-1298. [PMID: 23887003 DOI: 10.1097/acm.0b013e31829eb795] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE Understanding the association between attending physicians' workload and teaching is critical to preserving residents' learning experience. The authors tested the association between attending physicians' self-reported workload and perceptions of time for teaching before and after the 2003 resident duty hours regulations. METHOD From 2001 to 2008, the authors surveyed all inpatient general medicine attending physicians at a teaching hospital. To measure workload, they used a conceptual framework to create a composite score from six domains (mental demand, physical demand, temporal demand, effort, performance, frustration). They measured time for teaching using (1) open-ended responses to hours per week spent doing didactic teaching and (2) responses (agree, strongly agree) to the statement "I had enough time for teaching." They conducted multivariate logistic regression analyses, controlling for month, year, and clustering by attending physicians, to test the association between workload scores and time for teaching. RESULTS Of 738 eligible attending physicians, 482 (65%) completed surveys. Respondents spent a median of three hours per week dedicated to teaching. Less than half (198; 43%) reporting enough time for teaching. The composite workload scores were normally distributed (median score of 15) and demonstrated a weak positive correlation with actual patient volume (r = 0.25). The odds of an attending physician reporting enough time for teaching declined by 21% for each point increase in composite workload score (odds ratio = 0.79 [95% confidence interval 0.69-0.91]; P = .001). CONCLUSIONS The authors found that attending physicians' greater self-perceived workload was associated with decreased time for teaching.
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Affiliation(s)
- Lisa M Roshetsky
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, USA
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Tan M, Hooper Evans K, Braddock CH, Shieh L. Patient whiteboards to improve patient-centred care in the hospital. Postgrad Med J 2013; 89:604-9. [PMID: 23922397 DOI: 10.1136/postgradmedj-2012-131296] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patient whiteboards facilitate communication between patients and hospital providers, but little is known about their impact on patient satisfaction and awareness. Our objectives were to: measure the impact in improving patients' understanding of and satisfaction with care; understand barriers for their use by physicians and how these could be overcome; and explore their impact on staff and patients' families. METHODS In 2012, we conducted a 3-week pilot of multidisciplinary whiteboard use with 104 inpatients on the general medicine service at Stanford University Medical Center. A brief, inperson survey was conducted with two groups: (1) 56 patients on two inpatient units with whiteboards and (2) 48 patients on two inpatient units without whiteboards. Questions included understanding of: physician name, goals of care, discharge date and satisfaction with care. We surveyed 25 internal medicine residents regarding challenges of whiteboard use, along with physical therapists, occupational therapists, case managers, consulting physicians and patients' family members (n=40). RESULTS The use of whiteboards significantly increased the proportion of patients who knew: their physician (p≤=0.0001), goals for admission (p≤=0.0016), their estimated discharge date (p≤=0.049) and improved satisfaction with the hospital stay overall (p≤=0.0242). Physicians, ancillary staff and patient families all found the whiteboards to be helpful. In response, residents were also more likely to integrate whiteboard use into their daily work flow. CONCLUSIONS Inpatient whiteboards help physicians and ancillary staff with communication, improve patients' awareness of their care team, admission plans and duration of admission, and significantly improve patient overall satisfaction.
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Affiliation(s)
- Marilyn Tan
- Department of Medicine, Stanford University Medical Center, , Stanford, California, USA
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O'Brien BC, Irby DM. Enacting the Carnegie Foundation call for reform of medical school and residency. TEACHING AND LEARNING IN MEDICINE 2013; 25 Suppl 1:S1-S8. [PMID: 24246101 DOI: 10.1080/10401334.2013.842915] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
On the 100th anniversary of the Flexner Report, the Carnegie Foundation for the Advancement of Teaching published a new study of medical education. This study, titled Educating Physicians: A Call for Reform of Medical Schools and Residency Programs, contained four primary recommendations intended to stimulate innovation and improvement in medical education. In this article, the authors examined the ways others have applied the four recommendations from Educating Physicians within and beyond medical education. In their review of 246 publications citing the Carnegie work, they found that the recommendation for integration was addressed most frequently, often through descriptions of integration of curricular content in undergraduate medical education. The recommendation to focus on professional identity formation was the second most frequently addressed, followed by standardization and individualization, then inquiry, innovation, and improvement. The publications related to these latter three recommendations tended to be conceptual rather than descriptive or empirical. Publications spanned the continuum of medical education (from medical school to residency to physicians in practice) and even into other fields, but undergraduate medical education received the most attention. The authors discuss common themes among the citing publications and highlight opportunities for further discussion and innovation. Many exciting developments have occurred in medical education and beyond since the publication of Educating Physicians in 2010. Thus far, most of the publications citing the Carnegie recommendations describe incremental changes in medical education, particularly in the area of integration. Some of the conceptual work around these recommendations, coupled with a variety of external factors such as changes in health care and accreditation systems, suggests the potential for changes that are more transformative in nature.
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MESH Headings
- Curriculum/standards
- Curriculum/trends
- Diffusion of Innovation
- Education, Medical, Graduate/standards
- Education, Medical, Graduate/trends
- Education, Medical, Undergraduate/standards
- Education, Medical, Undergraduate/trends
- Humans
- Internship and Residency/standards
- Internship and Residency/trends
- Models, Educational
- Professional Competence/standards
- Quality Improvement
- Schools, Medical/organization & administration
- United States
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Affiliation(s)
- Bridget C O'Brien
- a Office of Research and Development in Medical Education , University of California , San Francisco , California , USA
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Cumyn A, Harris IB. A comprehensive process of content validation of curriculum consensus guidelines for a medical specialty. MEDICAL TEACHER 2012; 34:e566-e572. [PMID: 22489987 DOI: 10.3109/0142159x.2012.668623] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In this article, we outline an innovative and comprehensive approach to the development by consensus of curriculum content guidelines for a medical specialty. We initially delineated the content domain by triangulation of sources, validated a curriculum blueprint by both quantitative and qualitative methodology, and finally reached consensus on content by Delphi methodology. Development of curricular objectives is an important step in curriculum development. Content definition or "blueprinting" refers to the systematic definition of content from a specified domain for the purpose of creating test items with validity evidence. Content definition can be achieved in a number of ways and we demonstrate how the concepts of content definition or validation can be transferred beyond assessment, to other steps in curriculum development and instructional design. Validity in Education refers to the multiple sources of evidence to support the use or interpretation of different aspects of a curriculum. In this approach, there are multiple sources of content-related validity evidence which, when accumulated, give credibility and strength to curriculum consensus guidelines.
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Affiliation(s)
- Annabelle Cumyn
- Centre Hospitalier Universitaire Sainte-Justine, Cookshire-Eaton, QC, Canada.
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