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Gaiser RR, Fardelmann KL, Chawla N, Kinney DA. Anesthesiology: Perioperative medicine or service? J Clin Anesth 2022; 78:110679. [PMID: 35149307 DOI: 10.1016/j.jclinane.2022.110679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Robert R Gaiser
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, PO Box 208051, New Haven, CT 06520, United States of America.
| | - Kristen L Fardelmann
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, PO Box 208051, New Haven, CT 06520, United States of America
| | - Nikhil Chawla
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, PO Box 208051, New Haven, CT 06520, United States of America
| | - Daniel A Kinney
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, PO Box 208051, New Haven, CT 06520, United States of America
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Torabi A, Khemka A, Bateman PV. A Cardiology Handbook App to Improve Medical Education for Internal Medicine Residents: Development and Usability Study. JMIR MEDICAL EDUCATION 2020; 6:e14983. [PMID: 32297866 PMCID: PMC7193443 DOI: 10.2196/14983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 01/24/2020] [Accepted: 02/07/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND At most institutions, internal medicine residents struggle with balancing clinical duties and learning opportunities, particularly during busy cardiology ward rotations. To improve learning experiences for residents, we helped develop a cardiology handbook app to supplement cardiology education. OBJECTIVE The aim of this study was to report the development, implementation, and preliminary impact of the Krannert Cardiology Handbook app on graduate medical education. METHODS In June 2017, 122 residents at Indiana University were invited to download the digital handbook in the Krannert app. The Krannert app featured a total of 13 chapters written by cardiology fellows and faculty at Indiana University. Residents were surveyed on their self-reported improvement in cardiology knowledge and level of satisfaction after using the Krannert app. Residents were also surveyed regarding their preference for a digital handbook app versus a paper handbook. RESULTS Of the 122 residents, 38 trainees (31.1%) participated in survey evaluations. Among all respondents, 31 app users (82%) reported that the app helped improve their cardiology knowledge base. The app had an overall favorable response. CONCLUSIONS The Krannert app shows promise in augmenting clinical education in cardiology with mobile learning. Future work includes adding new topics, updating the content, and comparing the app to other learning modalities.
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Affiliation(s)
- Asad Torabi
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Abhishek Khemka
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Pantila V Bateman
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, United States
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Cleland J, Durning SJ. Education and service: how theories can help in understanding tensions. MEDICAL EDUCATION 2019; 53:42-55. [PMID: 30357894 DOI: 10.1111/medu.13738] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/09/2018] [Accepted: 06/18/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES This paper reviews why tensions between service and education persist and highlights that this is an area of medical education research (MER) that, to date, lacks a robust body of theory-driven research. After carrying out a review of the literature on service-education tensions in medical education and training, we turn to consider how theory can help provide new insights into service-education tensions. METHODS We conducted a search of the literature on service-education tensions since 1998 to examine the use of theory in studies on this topic. RESULTS We identified 44 out of 603 relevant papers. Their focus fell into four broad categories: time residents spent on 'service' and 'education'; perceptions of the balance between service and education; considerations of how best to define service and education, and the impact of structural and systems changes on education/training. Of the papers reporting primary research, the dominant methodology was the bespoke survey. Rarely were the precise natures of tensions or how different factors interact to cause tensions examined in detail. DISCUSSION Through discussion and reflection, we then agreed on the applicability of four sociocultural theories for illuminating some examples of service-education tensions. We present four sociocultural theories: Holland's figured worlds, Kemmis et al.'s practice architectures, Lave and Wenger's situated learning and Engeström's cultural-historical activity theory (CHAT or AT). We describe each and then briefly illustrate how each theory can support new ways of thinking and potential directions for research focusing on education-service tensions. CONCLUSIONS The use of theory in research studies will not resolve service-education tensions. However, what theory can do is illuminate and magnify different aspects of service-education tensions, to generate new insight and knowledge that can then be used to inform future research and changes in practice.
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Affiliation(s)
- Jennifer Cleland
- Centre for Healthcare Education Research and Innovation (CHERI), School of Medicine, Dentistry and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Steven J Durning
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Cleland J, Roberts R, Kitto S, Strand P, Johnston P. Using paradox theory to understand responses to tensions between service and training in general surgery. MEDICAL EDUCATION 2018; 52:288-301. [PMID: 29105861 DOI: 10.1111/medu.13475] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/26/2017] [Accepted: 09/06/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT The tension between service and training in pressured health care environments can have a detrimental impact on training quality and job satisfaction. Yet the management literature proposes that competing demands are inherent in organisational settings: it is not the demands as such that lead to negative outcomes but how people and organisations react to opposing tensions. We explored how key stakeholders responded to competing service-training demands in a surgical setting that had recently gone through a highly-publicised organisational crisis. METHODS This was an explanatory case study of a general surgery unit. Public documents informed the research questions and the data were triangulated with semi-structured interviews (n = 14) with key stakeholders. Data coding and analysis were initially inductive but, after the themes emerged, we used a paradox lens to group themes into four contextual dimensions: performing, organising, belonging and learning. RESULTS Tensions were apparent in the data, with managers, surgeons and trainees or residents in conflict with each other because of different goals or priorities and divergent perspectives on the same issue of balancing service and training (performing). This adversely impacted on relationships across and within groups (belonging, learning) and led to individuals prioritising their own goals rather than working for the 'greater good' (performing, belonging). Yet although relationships and communication improved, the approach to getting a better balance maintained the 'compartmentalisation' of training (organising) rather than acknowledging that training and service cannot be separated. DISCUSSION Stakeholder responses to the tensions provided temporary relief but were unlikely to lead to real change if the tension between service and training was considered to be an interdependent and persistent paradox. Reframing the service-training paradox in this way may encourage adjusting responses to create effective working partnerships. Our findings add to the body of knowledge on this topic, and will resonate with all those engaged in surgical and other postgraduate training.
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Affiliation(s)
- Jennifer Cleland
- Centre for Healthcare Education Research and Innovation (CHERI), School of Medicine, Dentistry and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Ruby Roberts
- Centre for Healthcare Education Research and Innovation (CHERI), School of Medicine, Dentistry and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Simon Kitto
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada
| | - Pia Strand
- The Faculty of Medicine Centre for Teaching and Learning, Lund University, Lund, Sweden
| | - Peter Johnston
- NHS Education for Scotland, Northern Deanery, Aberdeen, UK
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Kesselheim JC, Schwartz A, Boyer D. Integrating Education and Service in Pediatric Residency Training: Results of a National Survey. Acad Pediatr 2017; 17:907-914. [PMID: 28668724 DOI: 10.1016/j.acap.2017.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 06/13/2017] [Accepted: 06/22/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The definition and proper role of service, as it relates to education, in the residency training experience has been long debated. In this study we aimed to develop definitions for service and education, delineate how each is perceived to contribute value to training, and to measure respondents' ratings of service and education using case vignettes. METHODS We conducted a multisite cohort survey study of pediatric residents (n = 797) and program directors (PDs; n = 37) using a region-stratified sample of 2 to 3 participating pediatric residency programs per region. RESULTS Surveys were completed by 34 PDs (92%) and 359 trainees (45%). PDs and residents agree that service can, in the absence of formal teaching, be considered educational. When asked how often rotations provide an appropriate balance between education and service, 94% of PDs responded 'extremely/very often' whereas only 68% of residents agreed (P = .005). Residents were significantly more likely than PDs to endorse definitions for service that included volunteer work (82% vs 59%; P = .002), going above and beyond for a patient (91% vs 78%; P = .017), and routine patient care activities (91% vs 72%; P < .001). For 6 of 12 case vignettes, trainees gave median service ratings that were significantly higher than PDs (P = .03). CONCLUSIONS Medical educators and pediatric residents hold mismatched impressions of their training programs' balance of service obligations with clinical education. Specifically, residents more frequently report an overabundance of service. Both groups acknowledge that service activities can be educationally valuable although the groups' definitions of service are not fully aligned.
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Affiliation(s)
- Jennifer C Kesselheim
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Mass.
| | - Alan Schwartz
- Departments of Medical Education and Pediatrics, University of Illinois at Chicago
| | - Debra Boyer
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Mass
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Catalanotti JS, Amin AN, Caverzagie K, Gilden J, Walsh K, Vinciguerra SF, Laird-Fick HS. Balancing Service and Education: An AAIM Consensus Statement. Am J Med 2017; 130:237-242. [PMID: 27984011 DOI: 10.1016/j.amjmed.2016.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
Affiliation(s)
| | - Alpesh N Amin
- Department of Medicine, University of California-Irvine
| | - Kelly Caverzagie
- Department of Internal Medicine, University of Nebraska College of Medicine, Omaha
| | - Janice Gilden
- Department of Medicine, Rosalind Franklin University of Medicine and Science/Chicago Medical School, North Chicago, Ill
| | - Katherine Walsh
- Department of Internal Medicine, Ohio State University, Columbus
| | | | - Heather S Laird-Fick
- On behalf of the AAIM Education Committee, Department of Medicine, Michigan State University, East Lansing
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Abstract
Given the meteoric rise in physician assistants and nurse practitioners in critical care units across the United States, identifying successful paradigms with which to train these clinicians is critical to help meet current and future demands. We describe an apprenticeship model of training that is deployable in any ICU including curriculum, didactic and procedural training, as well as 3- and 6-month benchmarks that embraces dedicated intensivist mentorship.
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Hendershot KM, Woods R, Parikh PP, Whitmill M, Runkle M. Service vs education: situational and perceptional differences in surgery residency. JOURNAL OF SURGICAL EDUCATION 2014; 71:e111-e115. [PMID: 25037505 DOI: 10.1016/j.jsurg.2014.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/30/2014] [Accepted: 06/12/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE This study determined whether situational or perceptional differences exist when trying to define what constitutes "service" and "education" in surgery residency in relation to the Accreditation Council of Graduate Medical Education (ACGME) survey. DESIGN An institutional review board-approved, single institute, cross-sectional study was conducted through a survey. Participants were asked to rate common resident tasks. Participants were also asked general questions regarding "service" and "education." SETTING Wright State University surgery program, Dayton, OH. PARTICIPANTS The study included 69 participants, which included medical students (19), residents (26), nurses/advanced practitioners (14), and attending surgeons (10). RESULTS A significantly high number of attending surgeons reported that writing a history and physical examination is educational compared with residents and students. Similar results were found regarding talking with patients/families. Drawing blood and starting peripheral intravenous access were universally rated as service tasks. For laparoscopic cholecystectomy, when the resident had done one previously, it was universally thought educational. When the resident had done more, most attending surgeons thought the task educational, but residents and students thought it much less educational. When analyzing only residents, in talking with families, most interns rated this as service, whereas postgraduate years 2 and 3 reported it as more educational and postgraduate years 4 and 5 ranked it equally as service and educational. Similar results were seen in answering nursing phone calls and writing admission orders. Residents (88%) and attending surgeons (90%) agreed that service is part of residency training. Only 40% of residents, however, stated they know what the term "service" means in regard to the ACGME survey. Overall, 80% of attending surgeons and 44% of residents agree that "service" has not been well defined by the ACGME. CONCLUSIONS Situational and perceptional differences do exist regarding "service" and "education" in our program, and most participants are unclear about the terms. As the definitions are situational and change with the person queried, then should this be the ACGME standard to assess programs and issue citations?
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Affiliation(s)
- Kimberly M Hendershot
- Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio.
| | - Randy Woods
- Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Priti P Parikh
- Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Melissa Whitmill
- Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Mary Runkle
- Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio
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Vanstone M, Watling C, Goldszmidt M, Weijer C, Lingard L. Resigned professionalism? Non-acute inpatients and resident education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2014; 19:529-539. [PMID: 24452443 DOI: 10.1007/s10459-013-9486-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 11/26/2013] [Indexed: 06/03/2023]
Abstract
A growing group of inpatients on acute clinical teaching units have non-acute needs, yet require attention by the team. While anecdotally, these patients have inspired frustration and resource pressures in clinical settings, little is known about the ways in which they influence physician perceptions of the learning environment. This qualitative study explored residents' and attending physicians' perceptions of caring for these patients, including their educational value. Using constructivist grounded theory, we conducted seven homogeneous focus groups and three interviews with residents and attending physicians from neurology and general internal medicine. A constant comparative analytical approach was employed alongside data collection, using theoretical sampling to explore emergent themes. Residents consistently described non-acute patients as non-educational, uninteresting, but still in need of care. Some attending physicians echoed this view, while others described multiple learning opportunities presented by non-acute patients. Both groups described residents as engaging with non-acute patients in a professional capacity, but not as learners. This engagement in a professional capacity could be considered diligent disinterest, or resigned professionalism. A constructivist understanding of the dynamics which influence learning in the workplace was used to explore the reasons why the residents in our study did not recognize the learning opportunities presented by non-acute patients. Our results resonate with Billett's theory of workplace affordances, which offers an explanation as to why learners may not identify or take advantage of potential learning opportunities. Overall, our study assists our understanding of the sociocultural factors that influence learners' choices to engage with particular clinical learning opportunities.
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Affiliation(s)
- Meredith Vanstone
- Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis, McMaster University, Communications Research Laboratory Rm 205, 1280 Main St W., Hamilton, ON, L8S 4K1, Canada,
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Kesselheim JC, Sun P, Woolf AD, London WB, Boyer D. Balancing education and service in graduate medical education: data from pediatric trainees and program directors. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:652-657. [PMID: 24556769 PMCID: PMC4885597 DOI: 10.1097/acm.0000000000000174] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To measure pediatric program directors' (PDs') and trainees' perceptions of and expectations for the balance of service and education in their training programs. METHOD In fall 2011, an electronic survey was sent to PDs and trainees at Boston Children's Hospital. Respondents described perceptions and expectations for service and education and rated the education and service inherent to 12 vignettes. Wilcoxon rank sum tests measured the agreement between PD and trainee perceptions and ratings of service and education assigned to each vignette. RESULTS Responses were received from 28/39 PDs (78%) and 223/430 trainees (52%). Seventy-five (34%) trainees responded that their education had been compromised by excessive service obligations; only 1 (4%) PD agreed (P < .0001). Although 132 (59%) trainees reported that service obligations usually/sometimes predominated over clinical education, only 3 (11%) PDs agreed (P < .0001). One hundred trainees (45%) thought rotations never/rarely/sometimes provided a balance between education and clinical demands compared with 2 PDs (7%) (P < .0001). Both groups agreed that service can, without formal teaching, be considered educational. Trainees scored 6 vignettes as having greater educational value (P ≤ .01) and 10 as having lower service content (P ≤ .04) than PDs did. CONCLUSIONS Trainees and medical educators hold mismatched impressions of their training programs' balance of service and education. Trainees are more likely to report an overabundance of service. These data may impact the interpretation of Accreditation Council for Graduate Medical Education survey results and should be incorporated into dialogue about future curricular design initiatives.
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Affiliation(s)
- Jennifer C Kesselheim
- Dr. Kesselheim is assistant professor of pediatrics, Department of Pediatric Oncology, Dana-Farber/Children's Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts. Ms. Sun is statistician, formerly with the Department of Pediatric Oncology, Dana-Farber/Children's Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts. Dr. Woolf is associate professor of pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts. Dr. London is statistician, Department of Pediatric Oncology, Dana-Farber/Children's Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts. Dr. Boyer is assistant professor of pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Galvin SL, Buys E. Resident perceptions of service versus clinical education. J Grad Med Educ 2012; 4:472-8. [PMID: 24294424 PMCID: PMC3546577 DOI: 10.4300/jgme-d-11-00170.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 05/14/2012] [Accepted: 05/28/2012] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education states that education needs to have priority over service. There is a potential for residents to have a negative perception of activities termed service. OBJECTIVE To understand how residents of one obstetrics and gynecology program conceptualize service and clinical education in their daily training experiences. METHODS We conducted a qualitative survey using semistructured interviews with 9 residents in obstetrics and gynecology. Verbatim transcripts underwent phenomenologic analysis for themes and statements exemplifying the essence and nuances of residents' experiences. RESULTS The conceptualization of service and clinical education encompassed 6 categories, with some overlap between terms. The category education encompassed (1) tasks and situations with some educational value termed indirect patient care; (2) tasks and situations with high educational values subdivided into direct patient care and teacher-learner interactions; and (3) traditional educational activities, including reflection. Service denoted: (1) tasks and situations with little to no educational value subdivided into indirect and direct patient care categories; (2) tasks and situations with some educational value described as direct patient care; and (3) community service to patients and communities. CONCLUSIONS Definitions and the relative educational value of service and clinical education experiences overlapped considerably, but they varied by systematic, environmental, and personal factors. Service was used interchangeably to connote negative experiences that interfered with educational goals and positive experiences at the core of the profession's higher calling, the raison d'être of many physicians. The community needs to agree on the definitions of these terms and clarify the meaning of an appropriate balance.
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Marco CA, Kowalenko T. Competence and challenges of emergency medicine training as reported by emergency medicine residents. J Emerg Med 2012; 43:1103-9. [PMID: 22883717 DOI: 10.1016/j.jemermed.2012.05.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 04/21/2012] [Accepted: 05/20/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND The American Board of Emergency Medicine conducts an annual survey of residents in Emergency Medicine, the Longitudinal Study of Residents in Emergency Medicine survey. OBJECTIVE This study was undertaken to describe self-reported competence and challenges facing Emergency Medicine (EM) residents. METHODS In this descriptive, observational analysis of the Longitudinal Study of Residents in Emergency Medicine survey, survey data from 1996-2008 were compared for 70 survey items. Responses were analyzed with means and 95% confidence intervals by post-graduate year (PGY) and over time. RESULTS A total of 496 residents were included in this study. Most participated for 3 years, for a total of 1320 total responses. The most serious day-to-day challenges reported by residents (overall median scores of 3 or more) included knowing enough, keeping up with the medical literature, having enough time for personal life, ancillary support, and having enough time for family. Current level of competence in areas deemed weakest by residents included grant writing, contract negotiation, academic writing, disaster planning, research, and financial management. Residents reported improved competence in most (15 out of 16) areas from PGY-1 to PGY-3 year of training. Resident reports of competence did not change significantly over time from 1998-2008 (15 out of 16 items). CONCLUSIONS Emergency Medicine residents identified several important day-to-day problems, including knowing enough, keeping up with the medical literature, and having enough time for a personal life. PGY-3 residents reported improved competence in almost all aspects of EM work and clinical EM as compared to PGY-1 residents. Knowledge of perceived competence and problems among EM residents is crucial to the development of improved educational approaches to address these issues.
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Affiliation(s)
- Catherine A Marco
- Department of Emergency Medicine, University of Toledo College of Medicine, Toledo, Ohio 43614, USA
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Rosenberg TL, Franzese CB. Extremes in Otolaryngology Resident Surgical Case Numbers. Otolaryngol Head Neck Surg 2012; 147:261-70. [DOI: 10.1177/0194599812444533] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Understand (1) significance between minimum, mean, and maximum case numbers for otolaryngology resident surgical procedures; (2) weaknesses of Accreditation Council for Graduate Medical Education (ACGME) resident case log system contributing to inaccurate data/case inflation; and (3) when excessive case load may transform education into service. Study Design Cross-sectional survey using a national database. Setting Academic otolaryngology residency programs. Subjects/Methods Review of otolaryngology resident national data reports from ACGME resident case log system performed from 2004 to 2010. Minimum, mean, standard deviation, and maximum values for total number of resident surgeon cases and for specific surgical procedures were compared. Case unbundling, resident data entry habits, and tracked vs untracked Current Procedural Terminology ( CPT) codes were reviewed. Results Mean total number of resident surgeon cases remained constant (1699.5 ± 424.2 to 1772.2 ± 517). Minimum total number of cases ranged from 730 to 811 (approaching 2 standard deviations below the mean). Zero was reported as the minimum case number for some procedures. Maximum for total number of cases increased (3559 to 4857) and surpassed the mean by 4 to 5 standard deviations. Some procedures have maximums greater than 11 standard deviations above the mean. The authors identified untracked CPT codes and variations in resident case log documentation habits. Conclusions Large differences between the minimum, mean, and maximum resident surgeon case numbers exist. Establishing minimum case number requirements for otolaryngology residents should be considered. Educational benefit derived from excessive case load is unclear. Critical examination of the ACGME resident case log system and resident documentation habits is needed to improve accuracy of reporting.
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Affiliation(s)
- Tara L. Rosenberg
- Department of Otolaryngology and Communicative Sciences University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Christine B. Franzese
- Department of Otolaryngology and Communicative Sciences University of Mississippi Medical Center, Jackson, Mississippi, USA
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Yarris LM, Fu R, LaMantia J, Linden JA, Gene Hern H, Lefebvre C, Nestler DM, Tupesis J, Kman N. Effect of an educational intervention on faculty and resident satisfaction with real-time feedback in the emergency department. Acad Emerg Med 2011; 18:504-12. [PMID: 21569169 DOI: 10.1111/j.1553-2712.2011.01055.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Effective real-time feedback is critical to medical education. This study tested the hypothesis that an educational intervention related to feedback would improve emergency medicine (EM) faculty and resident physician satisfaction with feedback. METHODS This was a cluster-randomized, controlled study of 15 EM residency programs in 2007-2008. An educational intervention was created that combined a feedback curriculum with a card system designed to promote timely, effective feedback. Sites were randomized either to receive the intervention or to continue their current feedback method. All participants completed a Web-based survey before and after the intervention period. The primary outcome was overall feedback satisfaction on a 10-point scale. Additional items addressed specific aspects of feedback. Responses were compared using a generalized estimating equations model, adjusting for confounders and baseline differences between groups. The study was designed to achieve at least 80% power to detect a one-point difference in overall satisfaction (α = 0.05). RESULTS Response rates for pre- and postintervention surveys were 65.9 and 47.3% (faculty) and 64.7 and 56.9% (residents). Residents in the intervention group reported a mean overall increase in feedback satisfaction scores compared to those in the control group (mean increase 0.96 points, standard error [SE] ± 0.44, p = 0.03) and significantly higher satisfaction with the quality, amount, and timeliness of feedback. There were no significant differences in mean scores for overall and specific aspects of satisfaction between the faculty physician intervention and control groups. CONCLUSIONS An intervention designed to improve real-time feedback in the ED resulted in higher resident satisfaction with feedback received, but did not affect faculty satisfaction with the feedback given.
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Affiliation(s)
- Lalena M Yarris
- Policy and Research in Emergency Medicine, Department of Emergency Medicine (LMY, RF), Oregon Health & Science University, Portland, OR, USA.
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Abstract
Medical residency is an educational enterprise directed toward producing clinicians who recognize and correctly manage disease. While formal graduate medical education provides didactics and bedside teaching to improve knowledge, individual learning efforts are essential to the educational experience. Keeping track of patient outcomes after disposition from the emergency department (ED) is a useful exercise in reviewing gaps in knowledge of the individual and deficiencies in systems-based care. In reviewing the agreement between admission and discharge diagnoses of a single resident over 4 years of residency, significant improvement in diagnostic accuracy was observed. This method of self-correction has potential to supplement formal residency education in emergency medicine.
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Affiliation(s)
- Kurt A Smith
- Department of Emergency Medicine, Vanderbilt University, Nashville, TN, USA.
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