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Haischer-Rollo GD, Aden JK, Percival CS, Drumm CM. A Multimodal, Resident-led Newborn Emergencies Night Curriculum. Mil Med 2023; 188:e3216-e3220. [PMID: 37208790 DOI: 10.1093/milmed/usad176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/15/2023] [Accepted: 05/04/2023] [Indexed: 05/21/2023] Open
Abstract
INTRODUCTION Following graduate medical education duty hour reform, many programs have migrated to a night float model to achieve duty hour compliance. This has led to increased focus on optimizing nighttime education. A 2018 internal program evaluation of the newborn night rotation revealed that most pediatric residents received no feedback and perceived little didactic education during their four-week, night float rotation. One hundred percent of resident respondents were interested in increased feedback, didactics, and procedural opportunities. Our objective was to develop a newborn night curriculum to ensure timely formative feedback, enhance trainee didactic experience, and guide formal education. MATERIALS AND METHODS A multimodal curriculum was designed to include senior resident-led, case-based scenarios, a pre- and post-test, a pre- and post-confidence assessment, a focused procedure "passport," weekly feedback sessions, and simulation cases. The San Antonio Uniformed Services Health Education Consortium implemented the curriculum starting from July 2019. RESULTS Thirty-one trainees completed the curriculum in over 15 months. There was a 100% pre- and post-test completion rate. Test scores rose from an average of 69% to 94% (25% increase, P < .0001) for interns and an average of 84% to 97% (13% increase, P < .0001) for third-year residents (PGY-3s). When averaged across domains assessed, intern confidence rose by 1.2 points and PGY-3 confidence rose by 0.7 points on a 5-point Likert scale. One hundred percent of trainees utilized the on-the-spot feedback form to initiate at least one in-person feedback session. CONCLUSIONS As resident schedules evolve, there is an increased need for focused didactics during the night shift. The results and feedback from this resident-led and multimodal curriculum suggest that it is a valuable tool to improve knowledge and confidence for future pediatricians.
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Affiliation(s)
- Gayle D Haischer-Rollo
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - James K Aden
- Department of Biostatistics, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Candace S Percival
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Caitlin M Drumm
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Hamill CS, Cabrera CI, Murthy H, Mowry S, Maronian N, Tamaki A. Initiation of a Night Float System in an Otolaryngology Residency: Resident Perception and Impact on Operative Volume. Laryngoscope 2021; 131:2211-2218. [PMID: 33797075 DOI: 10.1002/lary.29541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/14/2021] [Accepted: 03/17/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Evaluate resident perception on implementation of a night float (NF) system to an otolaryngology residency program. We compared these perceptions to Accreditation Council for Graduate Medical Education (ACGME) case log data. METHODS A retrospective anonymous survey was sent to residents and alumni graduating between 2015 and 2023. Deidentified ACGME case log information was then examined for key indicator (KI) cases from post graduate year (PGY) 2 and PGY5. RESULTS Thirty (93.8%) residents and alumni responded. Residents with NF answered more positively compared to those without NF on following duty hour violations: 80-hour work week, 1-in-7 days off, 1 call every 3 days, adequate time between shifts, and allotted time after a 24-hour shift. Residents most commonly agreed that NF has improved patient care, resident education, and resident morale. Although residents with NF were neutral on PGY2 case volume effects, they disagreed that it affected overall case volume. The only KIs that differed for both PGY2 and PGY5s were airway cases (P = .004 vs P = .002) and bronchoscopy (P = .02 vs P = .006), which were significantly higher for those with NF. Thyroid surgery was the only KI higher for the residents without NF and spanned all PGY levels. CONCLUSION Residents and alumni agreed that NF implementation had a positive effect on duty hour violations. The NF system does not have significant impact on case volume. LEVEL OF EVIDENCE IV Laryngoscope, 2021.
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Affiliation(s)
- Chelsea S Hamill
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Henna Murthy
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Sarah Mowry
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Nicole Maronian
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Akina Tamaki
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
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Vater MR, Herndon A, Browning W, Johnson DP. Implementing and Maintaining an Increased Frequency of Nighttime Education Sessions. Hosp Pediatr 2020; 10:1102-1106. [PMID: 33168567 DOI: 10.1542/hpeds.2020-0048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Conferences are an essential component to resident education. Work hour requirements have led to night rotations, causing residents to miss this important educational experience. To fill this void, many institutions have created night curricula, but few have studied how to implement and sustain it. Our aim was to increase formal nighttime teaching led by upper level residents from 0 to ≥3 times weekly by December of 2018. METHODS After a needs-assessment survey was completed by upper level residents, pediatric night education sessions were established. Upper level residents on wards were responsible for teaching and recording whether nighttime teaching occurred. Data were collected by using this form, and a run chart was used to analyze the data over time. A team of hospitalists, pediatric residency program leadership, and a second-year resident met throughout the project and used the model for improvement. RESULTS Data were collected for 84 weeks. Introduction of the education sessions increased teaching occurrences from a baseline of 0 to a median of 1. After several plan, do, study, act cycles, most notably after implementing upper level feedback, special cause variation was achieved and median teaching occurrences increased to 3 times weekly. This was sustained for 32 weeks. CONCLUSIONS Focused quality improvement methodologies can be used to improve new residency program education. These methods can inform other residency programs how to successfully weave a teaching expectation into their night shifts to provide more learning opportunities in the era of duty hour requirements.
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Affiliation(s)
- McKenzie R Vater
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Alison Herndon
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Whitney Browning
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - David P Johnson
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
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Elhage SA, Watson MD, Green JM, Sachdev G. Distractions During Patient Handoff: The Application-Based Messaging Volume on General Surgery Interns. JOURNAL OF SURGICAL EDUCATION 2020; 77:e201-e208. [PMID: 32703741 DOI: 10.1016/j.jsurg.2020.06.032] [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: 04/15/2020] [Revised: 05/18/2020] [Accepted: 06/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Mobile phone-based paging systems have become increasingly common for communication within hospitals. Surgical interns receive the most pages, and our aim is to objectively quantify and evaluate this burden to allow for targeted improvement. DESIGN We performed a retrospective review of our institutions mobile phone-based paging system data (Halo Health, Cincinnati, OH) from July 2019 to September 2019. SETTING Carolinas Medical Center, Charlotte, NC, USA. PARTICIPANTS Seven general surgery postgraduate year (PGY) 1 residents. RESULTS Forty-five thousand eight hundred and one messages met inclusion criteria, with 27,397 messages received and 18,404 sent. PGY 1 residents each received an average of 48 ± 41 messages per shift, with 8 ± 17 messages per day while off-duty. Night shifts averaged more messages than day shifts (80 ± 39 vs 38 ± 32, p < 0.0001), and had more shifts with high message volume (30% vs 11%, p = 0.0005). Evaluating the total number of messages received per minute of the day, the largest number of high-volume message intervals (21) occurred during patient handoff (1700-1900 hours). Most messages were sent by nursing staff (55.8%), followed by medical providers (38.2%). CONCLUSIONS PGY 1 residents receive a large number of pages using a messaging application, with many occurring at critical times. Residents received a higher volume of pages on night shifts, during patient handoff, and while off-duty. Since most pages are from nursing staff, targeted education and preventative actions may help decrease the volume of pages during these critical times.
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Affiliation(s)
- Sharbel A Elhage
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Michael D Watson
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - John M Green
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Gaurav Sachdev
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina.
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Plotkin JB, Xu EJ, Fine DM, Knicely DH, Sperati CJ, Sozio SM. A Night Float System in Nephrology Fellowship: A Mixed Methods Evaluation. KIDNEY360 2020; 1:631-639. [PMID: 35372934 PMCID: PMC8815554 DOI: 10.34067/kid.0001572020] [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: 03/25/2020] [Accepted: 05/06/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND Johns Hopkins was an early adopter of an in-house nephrology fellowship night float to improve work-life balance. Our study aimed to elucidate attitudes to guide fellowship structuring. METHODS We performed a mixed-methods study surveying Johns Hopkins fellows, alumni, and faculty and conducting one focus group of current fellows. Surveys were developed through literature review, queried on a five-point Likert scale, and analyzed with t and ANOVA tests. The focus group transcript was analyzed by two independent reviewers. RESULTS Survey response rates were 14 (100%) fellows, 32 (91%) alumni, and 17 (94%) faculty. All groups felt quality of patient care was good to excellent with no significant differences among groups (range of means [SD], 4.1 [0.7]-4.6 [0.7]; P=0.12), although fellows had a statistically significantly more positive view than faculty on autonomy (4.6 [0.5] versus 4.1 [0.3]; P=0.006). Fellows perceived a positive effect across all domains of night float on the day team experience (range, 4.2 [0.8]-4.6 [0.6]; P<0.001 compared with neutral effect). Focus group themes included patient care, care continuity, professional development, wellness, and structural components. One fellow said, "…my bias is that every program would switch to a night float system if they could." All groups were satisfied with night float with 4.7 [0.5], 4.2 [0.8], and 4.0 [0.9] for fellows, faculty, and alumni, respectively; fellows were most enthusiastic (P=0.03). All three groups preferred night float, and fellows did so unanimously. CONCLUSIONS Night float was well liked and enhanced the perceived daytime fellow experience. Alumni and faculty were positive about night float, although less so, possibly due to concerns for adequate preparation to handle overnight calls after graduation. Night float implementation at other nephrology programs should be considered based on program resources; such changes should be assessed by similar methods.
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Affiliation(s)
- Jennifer B. Plotkin
- Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Eric J. Xu
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Derek M. Fine
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daphne H. Knicely
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - C. John Sperati
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen M. Sozio
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Carrera JF. A Systematic Review of the Use of Google Glass in Graduate Medical Education. J Grad Med Educ 2019; 11:637-648. [PMID: 31871562 PMCID: PMC6919184 DOI: 10.4300/jgme-d-19-00148.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/13/2019] [Accepted: 08/21/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Graduate medical education (GME) has emphasized the assessment of trainee competencies and milestones; however, sufficient in-person assessment is often constrained. Using mobile hands-free devices, such as Google Glass (GG) for telemedicine, allows for remote supervision, education, and assessment of residents. OBJECTIVE We reviewed available literature on the use of GG in GME in the clinical learning environment, its use for resident supervision and education, and its clinical utility and technical limitations. METHODS We conducted a systematic review in accordance with 2009 PRISMA guidelines. Applicable studies were identified through a review of PubMed, MEDLINE, and Web of Science databases for articles published from January 2013 to August 2018. Two reviewers independently screened titles, abstracts, and full-text articles that reported using GG in GME and assessed the quality of the studies. A systematic review of these studies appraised the literature for descriptions of its utility in GME. RESULTS Following our search and review process, 37 studies were included. The majority evaluated GG in surgical specialties (n = 23) for the purpose of surgical/procedural skills training or supervision. GG was predominantly used for video teleconferencing, and photo and video capture. Highlighted positive aspects of GG use included point-of-view broadcasting and capacity for 2-way communication. Most studies cited drawbacks that included suboptimal battery life and HIPAA concerns. CONCLUSIONS GG shows some promise as a device capable of enhancing GME. Studies evaluating GG in GME are limited by small sample sizes and few quantitative data. Overall experience with use of GG in GME is generally positive.
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Hajjar-Nejad MJ, Kubicki N, Morales D, Kavic SM. Multilevel Quality Improvement Teams: An Alternative Approach for Surgical Academic Training Programs to Meet ACGME Core Competency Milestones. JOURNAL OF SURGICAL EDUCATION 2019; 76:785-794. [PMID: 30472060 DOI: 10.1016/j.jsurg.2018.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/02/2018] [Accepted: 10/07/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Quality improvement (QI) activities are an integral part of residency training. We started the process to implement team-based, multilevel QI project streams within our academic surgical residency by studying resident perceptions. OBJECTIVE Our residency carried out 6 QI projects in line with the American Council for Graduate Medical Education competencies. A resident survey was completed in 2016 to measure resident perceptions of an individual versus team-based QI project approach. METHODS This was a descriptive study looking at resident's preference for team projects and ongoing projects within the training program. We started in 2014 utilizing Wait's Team Action Projects in surgery paradigm to conduct 6 QI projects. After initiation of projects, we allotted 2 full years to pass prior to assessing resident perceptions via a 12-item survey. RESULTS Notably, this was a descriptive study aiming to capture resident perceptions on team-based QI and the foundational elements necessary to create and sustain such projects by integrating into our curriculum from the intern year. In 2016, 40 residents completed surveys (72.7% response rate), all (100%) opined that they preferred team-based approaches over individual ones, and 75% were on board to move forward with only a team-based approach in the future. CONCLUSIONS This was a pivotal start to adopting a team-based QI project strategy in the future and laid a solid foundation to build upon. We found residents in our program desire to work within teams early on to develop effective solutions to clinical problems. Residents perceived that the team-based model resulted in an improved resident experience with the QI process and improved patient care. We hope to publish a series of articles updating our progress as we move forward in this endeavor.
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Affiliation(s)
| | - Natalia Kubicki
- University of Maryland School of Medicine, Baltimore, Maryland
| | - David Morales
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Stephen M Kavic
- University of Maryland School of Medicine, Baltimore, Maryland.
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Sani SN, Wistar E, Le L, Chia D, Haber LA. Shining a Light on Overnight Education: Hospitalist and Resident Impressions of the Current State, Barriers, and Methods for Improvement. Cureus 2018; 10:e2939. [PMID: 30202670 PMCID: PMC6128589 DOI: 10.7759/cureus.2939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Restrictions on resident work hours and increased requirements for resident supervision have led to night float rotations overseen by overnight hospitalists (nocturnists). The educational value of night float rotations for residents has traditionally been low and studies have yet to elucidate the optimal role of nocturnists in resident education. METHODS We performed a cross-sectional survey of all residents within our training program and attending hospitalists in the department of medicine at our three teaching medical centers. Questions sought to investigate the current state of overnight education within an internal medicine residency program, understand barriers to overnight education, and define best practices for nighttime teaching. RESULTS Both attending and resident physicians reported low satisfaction with the current state of overnight education, while simultaneously expressing high levels of interest in performing and receiving dedicated nighttime teaching. Attending and resident physicians identified similar barriers to overnight teaching (clinical work, time coordination, provider fatigue) and agreed on the ideal format for overnight didactics (case-based, chalk-talk, 20-minute duration between 10 pm to 2 am). CONCLUSION Our study identifies a desire by both faculty and trainees for increased overnight teaching and offers a simple initial framework for programs to improve overnight housestaff education utilizing nocturnist providers.
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Affiliation(s)
- Sara N Sani
- Medicine, University of California San Francisco, San Francisco, USA
| | - Emily Wistar
- Medicine, University of California San Francisco, San Francisco, USA
| | - Lien Le
- Gastroenterology, University of California San Diego, San Diego, USA
| | - David Chia
- Medicine, University of California San Francisco, San Francisco, USA
| | - Lawrence A Haber
- Medicine, University of California San Francisco, San Francisco, USA
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Development of a Night Float Call Model for Obstetrics and Gynaecology Residency: The Process and Residents' Perceptions. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:1061-1064.e1. [DOI: 10.1016/j.jogc.2016.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/24/2016] [Indexed: 11/18/2022]
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Affiliation(s)
- Adam S. Weltz
- Department of General Surgery University of Maryland Medical Center/University of Maryland School of Medicine Baltimore, Maryland
| | - Donald G. Harris
- Department of General Surgery University of Maryland Medical Center/University of Maryland School of Medicine Baltimore, Maryland
| | - Sarah Kidd-Romero
- Department of General Surgery University of Maryland Medical Center/University of Maryland School of Medicine Baltimore, Maryland
| | - Stephen M. Kavic
- Department of General Surgery University of Maryland Medical Center/University of Maryland School of Medicine Baltimore, Maryland
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