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Albert TJ, Starks H, Harrington W, Akwe J, Allaudeen N, Boggan JC, Carlson MA, Chun J, Cox L, Ehlers E, Alshaeba SE, Elzweig J, Fletcher KE, Garg M, Gasga A, Godwin PO, Hang MT, Jagannath AD, Kaneshiro C, Kwan B, Park JH, Schackmann E, Sehgal R, Sinex N, Smeraglio A, Tuck M, Turbyfill W, Vargas J, Cornia PB. The Evolution of Internal Medicine Chief Residents: A 20-Year Multicenter Study. Am J Med 2024:S0002-9343(24)00341-3. [PMID: 38848984 DOI: 10.1016/j.amjmed.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/31/2024] [Indexed: 06/09/2024]
Affiliation(s)
- Tyler J Albert
- VA Puget Sound Health Care System, Seattle, WA; Department of Medicine, University of Washington School of Medicine, Seattle, WA.
| | - Helene Starks
- Department of Medicine, University of Washington School of Medicine, Seattle, WA; Dept of Bioethics and Humanities, University of Washington School of Medicine, Seattle, WA
| | - Whitney Harrington
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Joyce Akwe
- Atlanta VA Health Care System, Atlanta, GA; Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Nazima Allaudeen
- VA Palo Alto Health Care System, Palo Alto, CA; Stanford University School of Medicine, Stanford, CA
| | - Joel C Boggan
- Durham VA Health Care System, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Marie A Carlson
- Durham VA Health Care System, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Jonathan Chun
- VA Palo Alto Health Care System, Palo Alto, CA; Stanford University School of Medicine, Stanford, CA
| | - LeeAnn Cox
- Richard L Roudebush VA Medical Center, Indianapolis, IN; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Erik Ehlers
- VA Nebraska-Western Iowa Health Care System, Omaha, NE; Department of Medicine, University of Nebraska College of Medicine, Omaha, NE
| | - Samer Ein Alshaeba
- VA Connecticut Health Care System, West Haven, CT; Department of Medicine, Yale University School of Medicine, West Haven, CT
| | - Joel Elzweig
- White River Junction VA Medical Center, White River Junction, VT; Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Kristen E Fletcher
- Lexington VA Health Care System, Lexington, KY; Department of Medicine, University of Kentucky College of Medicine, Lexington, KY
| | - Megha Garg
- San Francisco VA Health Care System, San Francisco, CA; Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA
| | - Arturo Gasga
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA
| | - Patrick O Godwin
- Jesse Brown VA Medical Center, Chicago, IL; Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Minh Tuan Hang
- Atlanta VA Health Care System, Atlanta, GA; Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Anand D Jagannath
- VA Portland Health Care System, Portland, OR; Department of Medicine, Oregon Health & Science University, Portland, OR
| | - Casey Kaneshiro
- VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Medicine, University of California Los Angeles School of Medicine, Los Angeles, CA
| | - Brian Kwan
- San Diego VA Medical Center, San Diego, CA; Department of Medicine, University of California San Diego School of Medicine, San Diego, CA
| | - Jung-Hyun Park
- Michael E. DeBakey VA Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Elizabeth Schackmann
- Department of Medicine, University of Washington School of Medicine, Seattle, WA; Boise VA Medical Center, Boise, ID
| | - Raj Sehgal
- South Texas Veterans Health Care System, San Antonio, TX; Department of Medicine, University of Texas San Antonio Long School of Medicine, San Antonio, TX
| | - Noelle Sinex
- Richard L Roudebush VA Medical Center, Indianapolis, IN; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Andrea Smeraglio
- VA Portland Health Care System, Portland, OR; VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Matthew Tuck
- Washington DC VA Medical Center, Washington, DC; Department of Medicine, George Washington University School of Medicine, Washington, DC
| | - William Turbyfill
- VA Eastern Colorado Health Care System, Aurora, CO; Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Jaclyn Vargas
- San Diego VA Medical Center, San Diego, CA; Department of Medicine, University of California San Diego School of Medicine, San Diego, CA; Department of Pediatrics, University of California San Diego School of Medicine, San Diego, CA
| | - Paul B Cornia
- VA Puget Sound Health Care System, Seattle, WA; Department of Medicine, University of Washington School of Medicine, Seattle, WA
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McDaniel LM, Molloy MJ, Blanck J, Beck JB, Shilkofski NA. The Chief Residency in U.S. and Canadian Graduate Medical Education: A Scoping Review. TEACHING AND LEARNING IN MEDICINE 2024:1-10. [PMID: 38247430 DOI: 10.1080/10401334.2023.2298870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024]
Abstract
PHENOMENON Despite the nearly universal presence of chief residents within U.S. and Canadian residency programs and their critical importance in graduate medical education, to our knowledge, a comprehensive synthesis of publications about chief residency does not exist. An understanding of the current state of the literature can be helpful to program leadership to make evidence-based improvements to the chief residency and for medical education researchers to recognize and fill gaps in the literature. APPROACH We performed a scoping review of the literature about chief residency. We searched OVID Medline, PsycINFO, ERIC, and Web of Science databases through January 2023 for publications about chief residency. We included publications addressing chief residency in ACGME specialties in the U.S. and Canada and only those using the term "chief resident" to refer to additional responsibilities beyond the typical residency training. We excluded publications using chief residents as a convenience sample. We performed a topic analysis to identify common topics among studies. FINDINGS We identified 2,064 publications. We performed title and abstract screening on 1,306 and full text review on 208, resulting in 146 included studies. Roughly half of the publications represented the specialties of Internal Medicine (n = 37, 25.3%) and Psychiatry (n = 30, 20.5%). Topic analysis revealed six major topics: (1) selection of chief residents (2) qualities of chief residents (3) training of chief residents (4) roles of chief residents (5) benefits/challenges of chief residency (6) outcomes after chief residency. INSIGHTS After reviewing our topic analysis, we identified three key areas warranting increased attention with opportunity for future study: (1) addressing equity and bias in chief resident selection (2) establishment of structured expectations, mentorship, and training of chief residents and (3) increased attention to chief resident experience and career development, including potential downsides of the role.
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Affiliation(s)
- Lauren M McDaniel
- Department of Pediatrics, Division of Hospital Medicine, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
| | - Matthew J Molloy
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jaime Blanck
- Informationist Services, Welch Medical Library, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jimmy B Beck
- Department of Pediatrics, Division of Hospital Medicine, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
| | - Nicole A Shilkofski
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA
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Kenaa B, Ramadan L, Njoku MJ, Holden VK, Gulati M. A Leadership Pathway in Patient Safety and Quality Improvement for Trainees. ATS Sch 2023; 4:413-422. [PMID: 38196676 PMCID: PMC10773278 DOI: 10.34197/ats-scholar.2023-0019ps] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/27/2023] [Indexed: 01/11/2024] Open
Abstract
Training house staff in patient safety and quality improvement (PSQI) requires multidisciplinary collaboration between program directors, graduate medical education, and hospital safety and quality leadership. A heavy clinical workload and limited protected time hinder trainees from engaging in a meaningful PSQI experience during their years of post-graduate training. This is further exacerbated by the lack of subject experts who are available to mentor young physicians. For pulmonary and critical care trainees who are actively involved in the management and care coordination of high-acuity patients, this lack of experience adds undue burden. The role of house officer for patient safety and quality improvement was implemented to engage those currently in training who have an interest in PSQI. Under the supervision of the hospital PSQI leaders, they are given optimal, purposeful immersion without impacting their primary training specialty. This skill set can then be incorporated into their future careers. In this review, we provide perspective on how this can be accomplished and provide a framework that can be expanded.
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Affiliation(s)
- Blaine Kenaa
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Leena Ramadan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | | | - Van K. Holden
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Mangla Gulati
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Raikhel AV, Blau K, Alberty K, Cornia P, Rodriguez RA, Steinberg KP, Wu C. Vax the Max, a Gamification Intervention for COVID-19 Vaccination Task Engagement in the Inpatient Setting. Am J Med Qual 2023; 38:47-56. [PMID: 36472420 PMCID: PMC9797123 DOI: 10.1097/jmq.0000000000000094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The development of vaccines for SARS-CoV-2 has offered game-changing protection from severe disease and death from COVID-19. Despite efforts to vaccinate individuals in the ambulatory setting, a sizable minority of the US population remains unvaccinated for COVID-19. For unvaccinated patients, hospitalization for non-COVID-19 illness offers another opportunity for vaccination. In the summer of 2021, the authors noted that COVID-19 vaccination rate for medicine inpatients at their hospital had fallen to 5.3 vaccine doses administered per 4-week block. In response, they created Vax the Max, a gamification program of COVID-19 vaccination tasks where internal medicine resident teams were awarded points for completing these tasks. Residents were anonymously surveyed after participation. The hospital demonstrated higher rates of administering the initial COVID-19 vaccine dose and completing the vaccine series in the inpatient setting per 4-week plan-do-study-act cycle after implementation of Vax the Max (5.3 versus 8.8 doses per plan-do-study-act cycle). Among residents, 76.8% reported that Vax the Max spurred their COVID-19 task engagement, and 66% reported that a similar gamification model could be utilized for a different clinical task in the future. An increase was observed in the COVID-19 vaccination rate for medicine inpatients after launching the Vax the Max competition. This occurred in the setting of resident turnover every 4 weeks, which normally makes practice sustainment more challenging. Despite this, a high degree of engagement was produced by itinerant residents. There is potential to explore similar gamification approaches involving resident physicians in areas of quality improvement and patient safety.
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Affiliation(s)
- A. Vincent Raikhel
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
- VA Puget Sound Healthcare System, Seattle, WA
| | - Kevin Blau
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
- VA Puget Sound Healthcare System, Seattle, WA
| | - Katherine Alberty
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
- VA Puget Sound Healthcare System, Seattle, WA
| | - Paul Cornia
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
- VA Hospitalist Service and Preoperative Medicine Consult Clinic, Section Head for Hospital Medicine, VA Puget Sound, Seattle, WA
| | - Rudolph A. Rodriguez
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
- VA Puget Sound Healthcare System, Seattle, WA
- VA Puget Sound Medical Center, VA Puget Sound Health Care System, Seattle, WA
| | - Kenneth P. Steinberg
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington Medical Center, Seattle, WA
| | - Chenwei Wu
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
- Housestaff Quality & Safety Committee, Seattle, WA
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Myers JS, Lane-Fall MB, Perfetti RH, Humphrey K, Sato L, Shaw KN, Taylor AM, Tess A. Demonstrating the value of postgraduate fellowships for physicians in quality improvement and patient safety. BMJ Qual Saf 2020; 29:645-654. [PMID: 31796578 DOI: 10.1136/bmjqs-2019-010204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/15/2019] [Accepted: 11/17/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Academic fellowships in quality improvement (QI) and patient safety (PS) have emerged as one strategy to fill a need for physicians who possess this expertise. The authors aimed to characterise the impact of two such programmes on the graduates and their value to the institutions in which they are housed. METHODS In 2018, a qualitative study of two US QIPS postgraduate fellowship programmes was conducted. Graduates' demographics and titles were collected from programme files,while perspectives of the graduates and their institutional mentors were collected through individual interviews and analysed using thematic analysis. RESULTS Twenty-eight out of 31 graduates (90%) and 16 out of 17 (94%) mentors participated in the study across both institutions. At a median of 3 years (IQR 2-4) postgraduation, QIPS fellowship programme graduates' effort distribution was: 50% clinical care (IQR 30-61.8), 48% QIPS administration (IQR 20-60), 28% QIPS research (IQR 17.5-50) and 15% education (7.1-30.4). 68% of graduates were hired in the health system where they trained. Graduates described learning the requisite hard and soft skills to succeed in QIPS roles. Mentors described the impact of the programme on patient outcomes and increasing the acceptability of the field within academic medicine culture. CONCLUSION Graduates from two QIPS fellowship programmes and their mentors perceive programmatic benefits related to individual career goal attainment and institutional impact. The results and conceptual framework presented here may be useful to other academic medical centres seeking to develop fellowships for advanced physician training programmes in QIPS.
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Affiliation(s)
- Jennifer S Myers
- Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Meghan Brooks Lane-Fall
- Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ross H Perfetti
- Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kate Humphrey
- Harvard Medical School, Boston, Massachusetts, USA
- General Pediatrics, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Luke Sato
- Harvard Medical School, Boston, Massachusetts, USA
- Patient Safety, Risk Management Foundation, Cambridge, Massachusetts, USA
| | - Kathy N Shaw
- Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - April M Taylor
- Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Anjala Tess
- Harvard Medical School, Boston, Massachusetts, USA
- Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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